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roots of a clinical intuition in counseling

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roots of a clinical intuition in counseling
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Daley, Lauren Pasquarella
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2006
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Constructivism ( jstor )
Counselor training ( jstor )
Educational counseling ( jstor )
Grounded theory method ( jstor )
Intuition ( jstor )
Medical treatment ( jstor )
Nurses ( jstor )
Nursing ( jstor )
Psychological counseling ( jstor )
School counseling ( jstor )

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ROOTS OF CLINICAL INTUITION IN COUNSELING:
A QUALITATIVE APPROACH












By

LAUREN PASQUARELLA DALEY


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA


2006














ACKNOWLEDGMENTS

I want to thank my husband, Matthew, for his support, love, and encouragement

throughout my entire doctoral program and particularly while writing this dissertation. He

was my rock to build upon whenever I struggled during my research. His support and

help also gave me the strength and will to finish my research in the times when finishing

did not seem probable. Without his love, motivation and assistance, furnishing this project

would not have been possible.

I also wish to thank my parents, Ron and JoAnn Pasquarella, for instilling a love

of education and a sense of curiosity in me, without which I would never have pursued

my doctorate.

I wish to also thank my advisor, Dr. Peter Sherrard, for giving me his support,

encouragement, and freedom to explore a nebulous topic. He gave me the latitude to

discover while also helping me when I got bogged down in the details. Our discussions

inspired me and triggered my own intuition regarding the direction of my research.

Without his guidance and motivation, I would not have finished this project.

I also want to thank my methodologist, Dr. Mirka Koro-Ljungberg for her

patience, understanding, encouragement and assistance throughout writing my

dissertation. I learned a great deal from her during my research and have opened my eyes

to a different point of view about science from working with her. Without her timeliness

in returning my drafts and direction in my study, finishing this dissertation would not

have been possible.









Finally, I wish to thank the remainder of my dissertation committee, Dr. Harry

Daniels, Dr. Mary Fukuyama, and Dr. Paul Schauble for their patience, assistance,

support and understanding while I wrote my dissertation. Without their openness to

discuss a topic such as intuition in a scholarly fashion, I would never have started the

project. Throughout the dissertation, their support and open-mindedness encouraged my

completion of this project.


















TABLE OF CONTENTS
Page


ACKNOWLEDGMENTS ................... ......................................................1


FIGURE............................................ ...- -------- --------


ABSTRACT ................... .......................................----------------------V


CHAPTER


1 INTRODUCTION ................... ................... ....................................


2 REVIEW OF THE LITERATURE ................... ................... ....................13


3 METHOD ................... ................... ........................................4


Data Collection ................... ................... .....................................5
Sampling ................... ................... ............ ................... ....5
Participants ................... ................... ......................................5
Interview Procedures ................... .....................................................5
Validity and Reliability ................... ................... ...............................6
Data Analysis ................... ................... .......................................6


4 FINDINGS ................... ................... ......................................6


5 IMPL ICATION S & CONCLUSIONS ................... ................... ................ 8 7


APPENDIX


A INITIAL INTERVIEW QUESTIONS ................... ................... ................98


B REVISED INTIAL INTERVIEW QUESTIONS ................... ................... .....99


C FOLLOW-UP INTERVIEW QUESTIONS ................... ................... .......1000


D SAMPLE THEORETICAL MEMO ................... ................... .................101


REFERENCES ................... .................. ................... ...................103


BIOGRAPHICAL SKETCH ................... ................... ..............................11















FIGURE


Figure paae

1 Theoretical Model of Clinical Intuition in Counseling ................... ............67








Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

ROOTS OF CLINCIAL INTUITION IN COUNSELING:
A QUALITATIVE APPROACH

By

Lauren Pasquarella Daley

May 2006


Chair: Peter A. Sherrard
Major Department: Counselor Education

The purpose of this study was to better define and understand how counselors

make meaning and how counselors use that meaning of their clinical intuition to help

clients by developing a preliminary theory of its use in counseling through a series of

semi-structured interviews with counselors that were analyzed using constructivist

grounded theory methodology.

The scholarly nursing, medical and business literature and the personal

experiences of counselors suggest that using intuition while counseling can benefit the

counseling process and thus benefit the client. However. the way counselors make

meaning of their intuitions and how they use them in practice has not been studied.

Constructivism states that individuals construct meaning of reality and the events

within that reality inside their individual minds. Grounded theory is a qualitative research

method aimed at developing a data-based theory. Using constructivism as my theoretical

foundation and grounded theory as my methodology, I studied two research questions:

how do counselors construct meaning of clinical intuition and how do counselors use the

constructed intuitions to help their clients? I interviewed five counselors with varying








levels of experience and coded the data according to grounded theory methodology. The

theory that emerged from the data is as follows: counselors construct meaning of clinical

intuition as a sense of knowing or awareness about their clients, resulting from the

counseling relationship, that they then communicate to the client, benefiting the

counseling process. The theory incorporates elements of defining what intuition is and

how the counselors receive or recognize it as intuition, the importance and cyclical nature

of the counseling relationship in generating clinical intuition, how counselors

communicate the intuitions to their clients, and also the boundaries and benefits of using

clinical intuition.

The research confirmed the concept that using clinical intuition while counseling

is beneficial to the counselor and the client. As a result, counseling training programs

should incorporate some aspect of teaching counselors to trust their intuitions so they use

them more regularly. Furthermore, managed care and insurance plans should support

counselors using clinical intuition as it moves the client toward therapeutic change more

quickly.














CHAPTER I
INTRODUCTION

The Roots of Clinical Intuition in Counseling: A Qualitative Approach

The ability to receive information from an unknown source has been a point of

psychological contention for many years. From an objectivist perspective, intuition is

often considered a nonsensical idea. However, with the surging public interest in these

topics, the various anecdotes describing personal experiences with such insights, and the

investigation of intuition/clinical intuition in the medical, nursing and business fields,

there is a trend toward examining these constructs from a research-based perspective.

Although the amount of research on intuition is growing, there have been relatively few

studies of the role intuition (clinical intuition) plays in counseling and for counselors.

Most of the intuition research has been conducted in the last fifty to sixty years.

However, interest in intuition is not new. Those able to "predict" the future have offered

guidance to seekers throughout the history of humankind. Intuition is not just the idea

that one can predict the future. Intuition is also the sense of knowing something before

having hard evidence for it. Additionally, Eastern medicine and native traditions have

long believed that warnings about disease and crisis can come through intuitive

knowledge (Sue & Sue, 1999). This belief that before any physical manifestation of

disease occurs, the mind-body-spirit sends warnings through intuition and dreams is

gaining limited acceptance in Western medicine, psychology, and counseling (Barasch,

1993).









Despite the long history describing intuition, the idea that everyone has this

intuitive ability is a relatively novel idea. Many contemporary authors believe that

intuition is an innate, natural, and important skill every person has and can develop

further (Day, 1996; De Becker, 1997; Emery, 1999; Faiver, McNally, & Nims, 2000;

Klein, 2003; Naparstek, 1997; Schulz, 1998; Shirley & Lagan-Fox, 1996; Vaughan,

1979). Not only is intuition viewed as a natural skill, but it is also considered by some to

be the voice of the soul, connecting the mind-body-spirit to its higher self (Naparstek,

1997: Zukay, I989).

This study will attempt to further describe and understand the phenomenon of

clinical intuition in counseling by interviewing counselors and analyzing the interviews

using grounded theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978;

Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998).

Definition of Intuition

What exactly is intuition? Many authors define intuition in different ways.

However, most definitions of intuition state that it is an unconscious, non-rational means

of receiving information. Popular culture and academic authors, although using different

language, often describe intuition in similar terms.

From a pop culture perspective, Day (1996) defines intuition as "a nonlinear,

nonempirical process of gaining and interpreting information in response to questions"'

(p. 83). Intuition is comprised of three primary modalities: precognition (knowing future

events), the intuitive experience (knowing current events), and dreams (either

precognitive or intuitive). Day (1996) noted that we may perceive information from

intuition through clairvoyance (seeing), clairsentience (feeling), and clairaudience









(hearing). Goldberg (1983) clarifies further that although intuition is often linked to the

psychic phenomena of precognition, ESP, telepathy, clairvoyance, and clairaudience,

only precognition and ESP are truly intuition. Goldberg (1983) believes that the intuition

of precognition occurs when people pick up information not available through our

ordinary five senses and is by definition extrasensory.

Other contemporary pop culture authors define intuition as "a clear knowing

without being able to explain how one knows, or knowledge gained without logical or

rational thought. Intuition is the receipt of information from a nonphysical database"

(Emery, 1999, p. 5); and/or "when we directly perceive facts outside the range of the

usual five senses and independently of any reasoning process" (Schulz, 1998, p. 19).

Naparstek (1997) describes intuition as "psi [her italics]--the knowing and sensing that

overleaps logic, analysis, and rational thought and just shows up. This is called intuition,

ESP. psychic ability, telepathy, clairvoyance, high sense perception, and paranormal

intelligence" (p. I5).

Scholarly definitions of intuition include similar concepts. One definition of

intuition "implies rapid understanding or knowledge without the conscious use of

reasoning" (Bowers, Regehr, Balthazard, & Parker, I990, p. 72). Another author

describes intuition as "[a] hunch .. events or processes that occur in the absence of

conscious mental will .. a bridging function that brings information into awareness in

the absence of directed mental activity" (Isenman, 1997, pp. 395-396). Hall (2002)

describes intuition as "cognitive 'short-circuiting' where a decision is reached even

though the reasons for the decisions cannot be easily described" (p. 216). In addition to

defining intuition as a means of obtaining and processing information, intuition is also








one of the perceptive functions of Jung's theory of personality type that reveals the

possibilities that may exist in what we have perceived (Andersen, 2000).

Hogarth (2001, pp. 6-7) provides an in-depth definition of intuition based on its

usage in Merriam-Webster's Collegiate Dictionary:

It refers, in one sense, to (a) "immediate apprehension or cognition," (b)
"knowledge or conviction gained by intuition," (c) "ithe power or faculty
of attaining to direct knowledge or cognition without rational thought and
inference" and, in a second sense to (d) "quick and ready insight." Thus
the common understanding is seen to involve elements of speed of
knowing (definitions ar and d) and the lack of a deliberate or rational
thought process (definition c). In addition, there is the notion of a store of
knowledge that has been built up over time through past intuitions
(definition b). Finally, a link is made to the notion of"insight"' (definition
d). Examining the concept of intuition in more depth, it is instructive to
consider it along the dimensions process, content, and correlatres [his
italics .

Hogarth (2001) goes on to describe the process of intuition as "characterized by a lack of

awareness of how outcomes--or judgments--have been achieved" (p.7); content as

''intuitive judgments are inferences that can look both backward and forward in time"' (p.

8). They can also represent "outcomes of a stock of knowledge"' (p. 8); correlates as ''the

term iniuitioon suggests certain correlartes [his italics]. Among these are notions of speed

and confidence .. However, neither speed nor certainty are necessarily correlates of

intuitive thought" (p. 10); and insight as "the phenomenon whereby people suddenly

become aware of the solution, or part of the solution, to a problem with which they are

confronted" (p. 12).

Definition of Clinical Intuition

Hogarth's (2001) definition of intuition incorporates the other definitions into a

more thorough explanation that involves elements of quick unconscious knowing,

inferences using hypotheses or beliefs to diagnose/describe/interpret past experience or









predict future experiences, expertise, certainty that our inferences are correct, and

problem solving. Expanding Hogarth (2001) to fit application in counseling, my

definition of clinical intuition is the speedy, unconscious knowing of information about a

client, used to form hypotheses about a client without rational, logical means of what sort

of treatments will work well with a client, and/or used to determine a new course of

action with a client if feeling stuck.

Carl Jung talked about clinical intuition (the ability of a skilled practitioner to

infer a problem without formal diagnosis) and as a means of identifying a personality trait

(Osbeck, 1999). Clinical intuition is similar to counselor judgment, which is "the process

of developing intuition, gathering information. and drawing conclusions about client

concerns" (Haverkamp. 1994, p. 156). Welsh and Lyons (2001, p.299) describe clinical

intuition as "the ability to 'sense' when something is not as it appears to be." Myers

(2002) states clinical intuition is composed of diagnostic intuition (predicting diagnoses)

and therapeutic intuition (predicting the best choice of therapy for the predicted

diagnosis). Each of the above clinical definitions touches on the basics of my definition,

although they do not describe the use of clinical intuition in moments of uncertainty with

clients. These moments of feeling stuck or not knowing how to proceed are ripe

situations for eliciting clinical intuition and therefore, an important component of clinical

intuition I added with my definition.

The Non-Rational Nature of Intuition and Why Studying Intuition is Important

Opponents of intuition have posed different views and different dermnitions. Many

authors describe intuition (all forms and types, including clinical intuition) as the

automatic information-processing that accompanies expertise in a variety of disciplines








(Gambril, 1990; Hall, 2002; Isenberg, 1991; Klein, 2003; Myers, 2002). Intuition is also

described as faulty thinking, incorrect logic, and full of cognitive biases and error by

some contemporary authors (Gambril, 1990, Hall, 2002; Myers, 2002).

Despite these criticisms, intuition and clinical intuition are by their definitions,

outside reason and therefore outside of rational inquiry. However, we cannot ignore

intuition for not fitting nicely into a technical rational "box": it is a valid means of

receiving credible information for many people and must be more deeply understood.

According to Paul Feyerabend (1978), scientific education and the currently

accepted methods of conducting scientific inquiry stifle the growth of knowledge and the

discovery of new ideas. He states that although many believe science needs its strict rules

to promulgate the authority of science, he believes that such strict rules strangulate the

process of discovery. Because the world is a largely unknown entity and we must keep

our options open while studying it, strictly adhering to any particular epistemology hurts

the progress of knowledge. Furthermore, Feyerabend (1978) states that the way we

currently teach science "'cannot be reconciled with a humanitarian attitude" (p. 20)

because it encourages suppressing liberty, individuality, and freedom in the name of

reason and/or scientific methodology.

Feyerabend (1978) stated that the current scientific standard of basing truth and

knowledge on verifiable observations and facts is not the sole method of dictating truth

and knowledge. By fostering such a standard of thought in our scientific education, we

are brainwashing conformists that cannot rely on their creativity or intuitions to find

novel research topics or novel approaches to previously studied phenomena. Creating

conformity in science allows scientists to maintain their '"authority" and to maintain the








status quo of their dominant paradigms by claiming their sole scientific method/approach

leads to absolute truth and knowledge. Feyerabend (1978) states that all methodologies

are flawed, all theories have inconsistent facts, and that there is no absolute truth, only

absolute conformism.

To break from the terror of reason, we must become anarchists (Feyerabend,

1978). Feyerabend (1978) defines anarchist as:

When choosing the term "'anarchism" for my enterprise I simply followed
general usage. However, anarchism, as it has been practised [sic] in the
past and as it is being practised [sic] today by an ever increasing number
of people has features I am not prepared to support. It cares little for
human lives and human happiness .. and it contains precisely the kind of
Puritanical dedication and seriousness I detest. .. It is for those reasons I
now prefer to use the term Dadatism~ [his italics]. (note, p.21).

Feyerabend believes that the brainwashing in our scientific education for using the

scientific method as the only valid means of knowing is so intrinsic in our Western

culture that even anarchists in other arenas buy into the myth of scientific reason and

knowledge. This devotion to the scientific method is pervasive and difficult to escape in

our culture. Scientific d'adacists should be able to look beyond this attachment to reason

and explore new topics in new ways.

Polanyi (1962) states the scientific community is its own political entity, ensuring

both the authority of its knowledge and its survival through widespread and subtle

manipulation of what is considered "scientific." According to Polanyi, scientific

knowledge is judged on its plausibility (credibility of the topic in light of current

scientific opinion) and its scientific value (an interplay between the accuracy of, the

systematic importance of, and the intrinsic appeal of the topic). The plausibility and

scientific value of topics interact with the originality of research ideas, making some








scientific topics more "valid" than others based on the quality of the interaction. Polanyi

(1962) further elaborates this notion by discussing the nature of facts. To Polanyi, facts

are never absolutely true but only considered as truth by the scientific community

because they fit in with the current scientific opinion.

Polanyi (1962) believes that science must enforce its standards to protect itself

from frauds, as a result, this protection becomes a necessary evil in that some ideas are

not considered scientific or "in vogue" until the historical era or paradigm changes

(Kuhn, 1962/1996). Scientific authority must balance tradition with originality of ideas

while simultaneously suppressing quacks and bad science.

As more and more journals accept and publish qualitative studies and as there are

many researchers in traditionally "rational'' fields (medicine, nursing, and business)

studying intuition, it appears that the paradigm is shifting to make room for more

qualitative research on intuition. As a result, it appears that the balance amongst

plausibility, scientific value and the creativity (Polanyi, 1962) of intuition might now be

"right" for studying intuition.

Because intuition is, by its very nature, non-rational, it does not mean it is less

important or less valuable to human decision-making or experiences. Faithfully adhering

to any one way of creating knowledge, such as the awesome devotion our modern

Western society gives to the scientific method, can ultimately limit what we know about

humans and the world in which we live to topics that may be easily studied by the

scientific method.

Rationale for the Current Study

The rationale for this study is to better define and understand how counselors









make meaning of and use their clinical intuitions with clients by using grounded theory

(Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967;

Strauss, 1987: Strauss & Corbin, 1998). Despite the many divergent views of intuition

and clinical intuition, there are relatively few empirical studies discussing clinical

intuition specifically in counseling. I hope to better understand how counselors construct

knowledge about their clients using clinical intuition.

I developed a theory/perspective (from a constructivist framework) that furthers

understanding of counselors' meaning and use of clinical intuition, based in data from my

participants. Since there is little empirical research on clinical intuition in general and

even less specifically to its use in counseling, grounded theory is a conceptually helpful

way to approach the topic. Additionally, as intuition is non-rational, using grounded

theory's more structured set of analytic tools will help to ground the analysis.

Subjectivity Statement

From an early age, I have had numerous experiences with various types of

knowing information without rational explanation. Mainly, these experiences were with

picking up the moods and feelings of friends, family, and strangers and the occasional

precognitive dream. I can consciously read people's emotions well but my intuitive

reading of emotions occurs differently, typically when a person hides her/his true

mood/feelings from me. For instance, a person smiles and acts in other verbal/nonverbal

ways that should communicate happiness. I frequently can sense when his/her true

feelings are quite well masked and are quite different than the emotional face the person

is wearing and stories the person is telling. However, I am aware that just because I can

sense the true mood/feelings does not mean someone is ready to discuss them. I also









intuitively sense the appropriate time for me to confront his/her affective dissonance and

not hurt or offend the person/client.

Throughout my life, I have seen the true feelings/moods of my friends, family,

strangers, associates, and more recently clients in counseling environments. I found

myself frustrated quite often that other people did not read me the way I could read their

emotions and moods; I thought everyone did it. The more people in my life I spoke with,

the more I realized my reading of people was not a trait shared by everyone. I began to

grow curious as to how this intuitive ability developed in me (and others like me) but not

mn everyone.

Additionally, my ability to intuitively pick up emotional cues has also helped me

avoid harm throughout my life; somehow, I can gauge if a situation or person is unstable,

dangerous, unhealthy, or harmful. I have never been able to explain it rationally nor have

I been able to verify the truth of my experience, because I act upon my intuition and will

go in the opposite direction from the possible harm; thus, no harm results and I cannot

know for certain if I was correct in my feelings.

I have had intuitive dreams most of my life. They usually fall more on the side of

precognition than on the academic view of intuition. Unfortunately, most of my

experiences with precognition involve dreaming about someone dying (usually someone I

am acquainted with or close to but occasionally a celebrity or stranger) and then, within a

few days, discovering that indeed the person died (except for strangers, I rarely confirm

their deaths because I never felt the need).

In addition to my death dreams, I often dream of friends in moments of crisis. I

may have not spoken to him/her for several months and I will dream of her/him in








emotional or physical pain. When I wake up, I feel compelled to check on the person

from my dream, and more often than chance, the person is going through a period of

upheaval, transition, anxiety, or depression. My precognitive and intuitive dreams always

have a different sense to them then my unconscious-working-out-my-daily-residue-ad

issues dreams; the precognitive or intuitive dreams are clearer and have a less "dream-

like"' quality to them. My friends and family think I am very bizarre for my dreams, so I

never assumed that everyone had them (although I believe everyone can). Wondering

how my dreams related to my waking intuition relates strongly to my curiosity about the

nature of intuition.

Once I began seeing clients during my master's and doctoral programs, I realized

that my intuitive skills greatly helped me during the counseling process. The experiences

of my clinical intuition are too numerous to describe; however, most of my clinical

intuitive experiences occurred spontaneously in session, when I could sense something

just not "fitting in"' with the clients' words. When I have been stuck with clients, my

intuition has helped me find new approaches and paths to follow with clients.

I never scientifically tested my experiences but I also never doubted their

accuracy and reality. When I began my doctoral training, I found my growing researcher

skills and knowledge conflicting with my intuitive processes. I felt caught between my

personal experiences and beliefs and knowing that these experiences and beliefs were not

"'scientific" or "rational." This cognitive dissonance between rational science and my

non-rational experiences sparked a growing curiosity in finding ways to work within the

technical rational system in order to bring some rational validity and understanding to my

non-rational experiences. Although there is wide acceptance in the non-academic world









and growing acceptance in the scholarly world of intuition research, it is often considered

too nebulous or mysterious a topic to study. The debate rages on between popular culture

and hard science. From my perspective, believing in intuition and believing in scientific

research are not mutually exclusive.

Because I have such vivid experiences with intuition in my personal life and

clinical intuition in my professional life, I do believe that using intuition is an important

and vital part of effective counseling. As grounded theory methods depend on the

worldview of the analyst, I will try to bracket my subjectivity as much as possible during

the data collection and analysis of my study.

Significance of Study

Intuition has been widely ignored by the scientific community because it was

considered implausible and without scientific value. Most writings on intuition involved

denigrating and outlining precisely why it was not valid in logical, rational thought and

some authors continue to do so despite intuition's growing acceptance in certain H'elds.

Recently, disciplines such as business science, nursing, and other medical fields have

changed their scientific opinions of intuition and clinical intuition; as a result, many more

theories and studies on intuition are appearing in each discipline's literature. It is my

belief that the field of counselor education is becoming ready to accept inquiry into the

use of intuition/clinical intuition in counseling.














CHAPTER 2
REVIEW OF THE LITERATURE

The "Scientific" Study of Intuition

Despite the scientific community's relative disregard for studies of intuition,

many inquiries have been performed on the concept during the past 100 years (Osbeck,

1999). Shirley and Lagan-Fox ( 1996) provide an excellent review of the early theories

and early empirical studies conducted on intuition. Many of these initial studies were

limited to the recording of anecdotes or were aimed at proving the existence of intuition

(Petitmengin-Peugeot, 1999). Recent writing and research into intuition describes it in

one of two ways: (1 ) the connection of intuition to the transpersonal, spiritual, and natural

healing; or (2) the information-processing/decision-making aspects of intuition and its

relationship to how various disciplines make professional decisions.

Most of the transpersonal literature agrees that intuition is a valid method of

receiving information and there is little debate that intuition exists. The transpersonal

perspective is that intuition is a gift that connects us to the universe. Much of the

transpersonal literature examines the nature of intuition and how we can use intuition to

make our lives (mind-body-spirit) and the lives of those around us more complete.

There is much debate in the literature regarding intuition and professional

decision-making. Some authors hail it as the way to go beyond what has become the

traditional, positivist approach of describing "truth'' (Redding, 2001; Schiin, 1983; Welsh








& Lyons, 2001). Some authors view intuition as one preference for processing

information (Myers, 1998; Jung, 1921/1971). Other authors view intuition as a natural

component of advanced critical thinking skills and/or expertise (De Bono, 1991;

Isenberg, 1991; Klein, 2003; Redding, 2001; Schain, 1983). Even other authors describe

intuition as riddled with bias and therefore has little part in professional decision-making

(Gambril, 1990; Hall, 2001; Myers, 2002).

Transpersonal Views of Intuition

Attempts to discuss intuition in the transpersonal and/or parapsychological

literature are usually aimed at trying to prove the existence of intuitive phenomena and

ignore the intuitive experience itself (Petitmengin-Peugeot. 1999). However, there is

some mention of the experience of intuition in the literature. Bohart (1999) describes the

intuitive experience based on qualitative descriptions of it from artists as nonconceptual,

realizations coming out of the blue, and a sense of imminence directly preceding the

insight. No formal preparation was necessary; the creative insights merely "dawned" on

the person.

The Intuitive Experience

Goldberg (1983) describes the intuitive experience in terms of incubation (time

away from the activity) and insight (when the intuition occurs). The intuition will be

holistic and received in a variety of different means through one of our senses, emotions,

or it can be a "'flash in the mind" (Goldberg, 1983, p. 72).

Based on interviews with people who have experienced intuition, Petitmengin-

Peugeot has formulated a generic model of the intuitive experience (1999). Gaining

insight from an unknown source is described as a process of four stages: letting go,








connecting to a higher source, listening to this higher source, and receiving the intuition.

The phase of letting go is a phase of quieting the rational mind, making it possible to shift

attention from normal, everyday consciousness to a higher, receptive level of awareness.

This can be done through shifting the center of attention from the head to the body by

changing posture, a gathering and realignment, transforming the breathing into a slow

pace and then shifting consciousness to the back of the skull (Petitmengin-Peugeot,

1999). While performing the body modification, mental activity must also be altered to

allow for visualization and/or prayer. A sense of abandoning normal reality occurs, with a

sense of feeling connected to the universe and a sense of opening up (1 999).

The connection phase occurs once the intuitive state has been reached. This

appears to be a deepening of the senses of connecting and opening up to receive

information. Based on the individual, this can be achieved unconsciously through

focusing on an object and altering your senses. However, some people described a

conscious process by introjecting (welcoming the other into one's self), extending

(opening the self further to accept the other) or resonating with the higher source

(Petitmengin-Peugeot. 1999).

After letting go, the person is in calm state, ready to receive insight from the

universe. This can be done through a special kind of attention: one that is "internal,

peripheral, and involuntary" (Petitmengin-Peugeot. 1999. p. 67). In addition to this

attention, the person will usually favor a particular 'listening' style among the visual

(clairvoyance), auditory (clairaudience) or kinesthetic (clairsentience) methods.

The stage of receiving the intuition is usually immediately preceded by a moment

of confusion leading to the clarity of the insight. Based on the preferred sense of








receiving the intuition, it will appear, bringing a feeling of certitude and coherence

(Petitmengin-Peugeot. 1999). To bring the insight into conscious awareness, the receiver

must consciously grasp, chase or welcome the intuition.

Spirituality, Psychic Intuition, and Health

Several studies presume intuition to exist and examine differences between the

modalities. In a study by Steinkamp (1998), the literature involving precognition and

clairvoyance testing from 1935-1997 was examined and a meta-analysis was performed

to determine which form of intuition is more effective at predicting the future

(Steinkamp, 1998). She found that there were no statistically significant differences to

support that clairvoyance works better than precognition. (Steinkamp. 1998).

In a later study by the same author, precognition was tested against clairvoyant

perceptions leading to a premonition. For example, did someone who predicted an

airplane disaster actually have a true premonition or did he just psychically pick up on a

faulty engine (Steinkamp, 2000)? The results seem to suggest that true precognition may

not be possible but that psychic feelings, sounds and visions are a reality (Steinkamp,

2000).

Other contemporary views of intuition hypothesize the connection of intuition to

the mind-body-spirit. in terms of an early warning system of disease. Many of the early

psychological theorists and contemporary researchers believe there is a connection

between the body and the mind (Barasch, 1993; Fernald, 2000; Freud, 1900/1965; Jung,

1954/1957/1960/1 977: Myers, Sweeney, & Witmer, 2000, Reich, 1972/1933). Although

several early theorists such as Carl Jung and William James acknowledged the role of

spirituality in health, serious research in this area has only recently begun (James, 1902;








Maltby & Day, 2001; Myers et al., 2000; Thoresen, 1999; Woods & Ironson, 1999). Total

health is comprised of and influenced by the interaction of all three elements (Barasch,

1993), i.e., it is logical that warnings of illness could arise in any of the dimensions; be it

a psychosomatic illness because of past trauma, the influence of attitude on heart disease,

or the mind-body-spirit warning of potential mental or physical illness through intuition

and dreams.

Intuitive Information-Processing and Decision-Making

The Functions of Intuition

Vaughan (1979) postulated that there are four levels of awareness for intuitive

experiences: physical, emotional, mental, and spiritual. Each level of awareness describes

the modality through which intuitive information is received.

Physical intuitions are those that "frequently depend on physical and emotional

cues that bring them to conscious awareness." (Vaughan, 1979, p. 66). These kinds of

intuitions are usually experienced at a physical level, such as a physical symptom or a pit

in the stomach. Emotional intuition "comes into consciousness through feelings"

(Vaughan, 1979, p. 68) such as an immediate like or dislike to a person without knowing

why or a feeling of connection with another person's feelings or thoughts. Vaughan

describes mental intuition as "'awareness through images, or what is called 'inner vision'"

(p. 73). Examples of this kind of intuition include unconscious pattern recognition that

allows a person to solve a problem or the ''Aha!" moment people may experience after

trying to solve a problem through rational thought with no avail. Finally, spiritual

intuition to Vaughan (1979) is "associated with mystical experience, and at this level,

intuition is "pure."' Pure, spiritual intuition is distinguished from other forms by its









independence from sensations, feelings, and thoughts"' (p. 77). Examples of spiritual

intuition are peak experiences, where one feels connected to the universe and appears to

comprehend the nature of reality.

Goldberg (1983) classifies intuition in into different functions: discovery,

creativity, evaluation, operation, prediction, and illumination. All of the functions

describe ways in which intuitive information serves the person receiving the intuitions.

Discovery intuition (Goldberg, 1983) is similar to Vaughan's (1979) description

of mental intuition, where one discovers a solution to an elusive problem. Creative

intuition often works with discovery but allows for novel approaches to art, science,

and/or life (Goldberg, 1983). Evaluative intuition does not examine or investigate choices

rationally as the name might suggest; examination and investigation are rational methods

(Goldberg, 1983). Instead, it gives a "'binary kind of function that tells us go or don't go,

or yes or no." (Goldberg, 1983. p. 51) such as when you knowt not to take a particular job

offer but can think of no logical reason to decline so you take it and the job ends badly.

Operational intuition is the "most subtle, almost spooky form .. [that] guides us

this way and that, sometimes with declarative force, sometimes with gentle grace. It

prompts us without telling us why, and sometimes without our knowing at all"

(Goldberg. 1983, p.54). Operational intuition is similar to evaluative intuition; however,

with evaluative intuition, there is a known decision to make or problem to solve. With

operational intuition, the "'answer" comes before the problem or decision.

Predictive intuition involves some intuitive decision and/or acting about the

future, either explicit or implicit, which is precise and not likely to be made by everyone

acting on the same limited information. For instance, if I regularly read the stock listings








and have seen a gradual increase in a particular stock that I then decide to buy and make a

lot of money on, that is not predictive intuition. However, it would be predictive intuition

if I knew absolutely nothing about stocks and had not heard about this stock before and

then decide to buy it and make a lot of money.

Finally, intuition as illumination is similar to Vaughan's (1979) concept of

spiritual intuition, in that it refers to those intuitions related to self~-realization,

communication with a higher power/the universe, and involves some element of

transcendence (Goldberg. 1983). An example of illuminative intuition would be if during

meditation, I felt a powerful, strong connection to the universe and understood the nature

of death for a fleeting moment that stayed with me after my meditation ended.

Jung's Theory of Psychological Type

Carl Jung (1921/1971 ) describes intuition as one of his four fundamental

psychological functions of the personality. According to Jung. intuition is a means of

perception through unconscious processes and is experienced through sensing the deep

significance and mystical connections of an everyday object or event (Hall. Lindzey, &

Campbell, 1998).

According to Andersen (2000), Jung's typology rests on two elements: attitudes

(way of reacting in life) & functions (how we orient ourselves in the world; a way of

solving problems) p. 47-48). These attitudes and functions are in our conscious

awareness. An important element of Jung's theory is that all the different attitudes and

functions are equally good; i.e., there is not one combination of attitudes and functions

that is the **best." People have a dominant attitude and function that they prefer. These

preferences comprise a person's psychological type.









There are two different ways of reacting in life: extraversion & introversion.

These attitudes differ in their directions of focus and their sources of energy (Andersen,

2000). Extraverts tend to act quickly, are more inclined towards action, and dislike

loneliness (Jung, 1921/1971). Introverts tend to react more slowly, integrate outside info

and are energized by alone time, unlike their extraverted counterparts (Jung, 1921/1971).

Functions describe the strategies people employ to acquire and process

information." (Hall, Lindzey, & Cam~pbell, 1998, p. 91). There are two different groups

of functions according to Jung's theory (1921/1971). The first category of function is

perception. The perception functions tell us how we perceive the world, the problem or

task and/or ways of taking in information (Andersen, 2000). Within this category, there

are two levels, sensing and intuition. Sensing is the function that tells us something exists

and is perception based on our senses. Sensing types perceive things as they are, have a

respect for facts & information, and are detail-oriented. In contrast, the function of

intuition reveals the possibilities which may exist in what we have perceived, that tells us

about the possibilities in the future, and enlightens us on the atmosphere surrounding all

experiences (Andersen, 2000). Intuitive types concentrate on possibilities and are less

concerned with the details. They often find solutions directly without basing them on

facts .

The next function category is j judgment. The judgment functions tell us how we

judge a problem or situation once it is perceived and includes our ways of making

decisions (Andersen, 2000). There are two levels within the judgment function: thinking

and feeling. Thinking is the function that tells us what something is, based on our existing

knowledge. Thinking types tend to be analytical, particular, precise, & logical. They see









things from an intellectual angle and often miss the emotional sides of a situation/

problem (Andersen, 2000). Feeling is the function that tells us how to relate to our

perceptions based on our subjective value system. Feeling types are interested in other

people's feelings and dislike analysis. They stick to their own values, their own likes, and

dislikes. They enjoy and prefer to work together with other people. (Andersen, 2000).

Developed by Isabel Myers and Katharine Briggs in 1940s, the Myers-Briggs

Type Indicator (MBTI) is one of the most widely studied and used assessment

instruments in the world (Sharf, 2002). The MBTI assesses psychological type based on

combinations of the attitudes and functions according to Jung's Theory of Psychological

Type and as modified by Katharine Briggs. There are sixteen combinations of types:

IST), ISFJ, INFJ, INTJ, ISTP, ISFP, INFP, INTP, ESTP, ESFP, ENFP, ENTP, ESTJ,

ESFJ, ENFJ, ENTJ. The last letter represents a third factor, not described by Jung's

theory. In addition to the two functions of perceiving and judging, a third factor was

added that describes which of the two functions a person finds more important.

According to Sharf (2002), judging types are organized, planned, decisive, set goals, and

are systematic. In contrast, perceiving types are flexible, spontaneous, tentative, let life

happen, undaunted by surprise, and open to change.

Andersen (2000) studied if intuitive managers (based on Jungian Type Theory)

were more effective managers than those using other decision-making processes.

Andersen examined 209 managers' decision-making styles according to Jungian Type

Theory, measured by the MBTI and the Keegan Type Indicator Form B. No statistically

significant differences found between decision-making style and managerial

effectiveness. However, 32% of effective managers used intuition as their primary mode









of perception. Although the study found no statistically significant differences between

intuitive managers and other managers, Andersen states that this investigation was merely

an exploratory & descriptive study to determine if the subject was worthy of further

study. Based on the high number of intuitive and effective managers, Andersen states that

more research is needed to further explore this connection.

Intuition and Creativity

Another contemporary view of intuition is that it is the foundation of creativity.

According to Bohart (1999), there is support in the literature for the idea that creativity

arises from "felt, tacit, intuitive and perceptual knowing" (p. 297). Creativity is not

limited to artistic expression. Generating novel ideas and problem solving, particularly in

moments of uncertainty can also be viewed as creativity.

Sternberg and Lubart (1991, as cited in Myers, 2002) describe five components to

creativity: (a) expertise; (b) imaginative thinking skills; (c) a venturesome personality; (d)

intrinsic motivation; and (e) a creative environment. Creative people can approach and

solve new situations and problems because they may have faced and solved similar

situations in the past (expertise); they can recognize patterns and see things in different

ways (imaginative thinking skills); they persevere, tolerate ambiguity/risk well, and seek

new experiences (venturesome personality); they are interested in solving problems for

self-satisfaction and not because of an outside influence (intrinsic motivation); and are in

environments were their ideas are sparked and developed in relationship to others

(creative environment). Intuition is the means creative people use to gain insight and

solve novel problems.









Intuition as a Component of Critical Thinking Skills

Myers (2002) examined the evidence for the powers and perils of intuition in

relationship to decision-making. Myers describes the validity of intuition as a perceptive,

automatic, cognitive process affected by memory, attention, expertise, evolution, social

experiences, creativity, and mental shortcuts. Intuition results from all of these things

interacting with one another and contributes to our effective decision-making. The most

intriguing part of Myers' book is his descriptions of divided attention and priming; and

the dual attitude system.

Myers (2002) postulates that intuition is simply our unconscious recognition and

perception of unattended stimuli incorporated into automatic, experiential knowing as a

result of implicit memory (learning something without remembering where we learned

it). Myers states that there are two ways of knowing: "automatic (unconscious) and

controlled (conscious)" (2002, p. 29). Additionally, Myers expounds these different ways

of knowing information as either experiential knowing or rational knowing (Epstein,

1994, as cited in Myers, 2002). Experiential knowing is "rapid, emotional, mediated by

vibes from past experience, self-evident, and generalized"' (Myers, 2002, p. 30). Rational

knowing, on the other hand, is "slow, logical, mediated by conscious appraisal, justified

with logic and evidence, and differentiated" (Myers, 2002, p. 30). According to Myers

(2002), intuition is therefore a part of our unconscious, experiential knowing system,

sometimes valid, but most of the time invalidated by its generalizability and therefore,

bias.

Much of the disagreement between scientists concerning the substance and

significance of intuition results from the non-rational basis of intuition. Science is, by its









nature, knowledge received through rational processes, aimed at refuting hypotheses and

beliefs in analytical, logical procedures. As described in Chapter 1, intuition is, by its

nature, knowledge received through often sudden, non-rational, non-analytical processes,

aimed at expanding understanding past or predicting future outcomes. Science and

intuition appear to be mutually exclusive.

However, several scholars have responded to the criticism of intuition in direct

and indirect ways (De Bono, 1991; Feyerabend, 1978; Polanyi, 1966/1983; Schain, 1983).

Similarly to Feyerabend (1978) and Polanyi (1962), Schain (1983) argues that Western

culture since the Age of Reason has nullified any other means of receiving and verifying

information outside the realm of "technical rationality"' (science). As a result, our

universities and critical thinkers of the day train future scholars to be future skeptics, only

trusting the technical rational method of discovering truth and knowledge. That is, we are

trained to believe that anything outside that proscribed scientific realm and methodology

is illogical and manipulative of non-critical thinkers.

Schiin (1983) described a different method of receiving and verifying information

termed "reflection-in-action" that is not necessarily more valid than the scientific method,

but occurs more often in practice. Practitioners often do not discover new knowledge

scientifically, they discover it through reflecting on the information in the moment,

testing their assumptions/hypotheses in the moment, and refuting/accepting these

hypotheses in the moment. Information received through reflection-in-action is a function

of expertise, a form of acquired tacit knowledge tapping into that automatic knowledge

store practitioners develop through their experiences. Schdn (1983) argues that relying









solely on a scientific research experiment, removed from the experiences of those in

practice, greatly limits our understanding of the world around us.

Sch~n's (1983) reflection-in-action through acquired tacit knowledge is similar to

Michael Polanyi's (1966/1 983) views when he states that as human beings, .. w~e can

know more than wie can tell [his italics] (p. 4), which he terms tacit knowledge. There

are two basic structures/kinds of knowing of tacit knowing: specifiably known

knowledge (i.e., something we know because we have attended to it) and functional

relational aspect of knowledge (i.e., something tacit that we only know because our

awareness of attending to the object). He also names these as the distal term (stimulus we

attend to, specifiably known) and the proximal term (tacit knowledge arising from our

attending to the fact that we attended to the stimulus). Polanyi (1966/1983) further states

that our full tacit knowledge of an event/interaction/stimulus is only made available to us

by ascribing meaning to the two terms and their interaction. Using Gestalt psychology

language to describe the proximal and distal terms, the proximal term represents the parts

and the distal term represents the Gestalt (or whole). We are aware of the whole by

making meaning out of the parts but we are not truly aware of the parts. This

unawareness of the 'parts' is the basis for tacit knowledge: that we know the whole

without knowing how we know the parts.

Polanyi (1966/1983) further discusses the nature of tacit knowledge by examining

the process of awareness. Polanyi states that we can .. make a thing function as the

proximal term of tacit knowing, we incorporate it in out body--or extend our body to

include it--so that we come to dwell in it." (p. I6). This indwelling of the proximal term

is similar to but more detailed than the concept of empathy. We can tacitly experience









knowledge of another by making their lives/experiences/ "parts" indwell in our minds.

Polanyi (1966/1983) believes that tacit knowledge allows us to bypass the process of

knowing through paying extremely close attention to everything around us thus avoiding

the problem of losing sight or meaning of something by paying to close attention to it.

Additionally, Polanyi states that if we try to elucidate and become aware of the tacit

process by which we know life, we will never fully be able to explain the process in a

way that makes the knowledge any more valid than it was tacitly. The act of trying to

make tacit knowledge conscious may cause us to lose sight of its meaning by paying to

close attention.

Polanyi's (1966/1983) ideas regarding tacit knowledge are similar to the concept

of intuition. Intuition is often defined as knowing something without knowing how we

know and not being able to tell how we know the intuition. From Polanyi's (1966/1983)

concept of tacit knowledge, we can further develop the concept of intuition to be an

unconscious awareness of an object's parts to more fully understand the object itself.

Intuition as tacit knowledge supports the view that intuition is a well-developed system of

pattern recognition postulated by authors such as Benner & Tanner (1984) and Schiin

(1983).

De Bono (1991) argues that there are two human thinking systems in decision-

making: vertical thinking and lateral thinking, each separate poles on a thinking

continuum. Vertical thinking is what we consider typical of a scientific approach to the

world; "it is selective. It seeks to judge. It seeks to prove and establish points and

relationships. .. It is concerned with stability with finding an answer so satisfactory

that one can rest with it" (De Bono, 1991, p. 19). De Bono (1991) further describes









vertical thinking as (a) judgment based on the "YES/NO system, and selection is by

exclusion of all those ideas to which the NO label can be attached" (p. 19); (b) "analytical

. .. interested in where an ideas comes from: this is the backward use of information .

used to describe [his italics] what has happened in one's own thinking" (p. 20); (c) "seeks

to establish continuity .. one step follows directly from the preceding step in a logical

sequence .. the conclusion must come after the evidence" (p. 20); (d) "chooses what is

to be considered. Anything else is rejected. This choice of what is relevant depends

entirely on the original way of looking at the situation" (p. 21); (e) "'proceeds along well-

established patterns because it is seeking proof and proof is most easily found by using

such patterns"' (p. 21); and (f) "promises at least a minimal result" (p. 21).

According to De Bono (1991), lateral thinking is the opposite of vertical thinking.

Lateral thinking is concerned with generating new possibilities, novel ideas, movement,

and change. Unlike vertical thinking, which is concerned with the stability of a

satisfactory answer, lateral thinking requires no adequate solution but strives to find a

better one. Lateral thinking is never an attempt to prove something and always an attempt

to generate new ideas. There is no judgment of right or wrong or YES/NO with lateral

thinking: in fact, De Bono (1991) states the "only 'wrong' is the arrogance or rigidity

with which an idea is held" (p. 20). Lateral thinking uses ideas to generate new ideas if

the current idea turns out to be inadequate.

In lateral thinking, the conclusion may come before the evidence. However, De

Bono (1991) states further:

This is not to say that one adopts a conclusion and then seeks to justify it
by rationalization. Such a procedure would imply an arrogant certainty in
the conclusion that is the opposite of lateral thinking. The process is rather
one of making a provocative jump to a new position and, once there, one









is suddenly able to see things in a new way. The new way must of course
prove itself by being effective (pp. 20-21).

Additionally, lateral thinking welcomes an amount of chance in generating new ideas,

because chance is one way of creating discontinuity in a situation (De Bono, 1991).

Finally, lateral thinking does not promise an answer to the solution, but if skilled in

lateral thinking, there is a high probability that a solution will emerge (De Bono, 1991).

De Bono ( 1991 ) does not imply that the two processes of thought are separate,

one can use both vertical and lateral thinking or a mixture of the two on a continuum.

Based on its above descriptions, lateral thinking seems very similar to intuition and is

useful in situations where a new approach or solution is needed for an uncertain problem

and vertical thinking is useful in determining if the new approach or solution is effective.

Unfortunately f~or most problem-solvers, De Bono (1991) states that most people "might

use lateral thinking some 5 percent of the time and vertical thinking 95 percent of the

time. .. It depends a good deal on the nature of the situation" (p. 22). The good news is

that lateral thinking skills can be developed and tuned, just as vertical thinking skills are

during our traditional education.

Although De Bono (1991) never specifically mentions intuition as being a part of

lateral thinking, intuition closely follows the description of lateral thinking. The process

of lateral thinking can also explain how intuition is separate from bias, in lateral thinking,

one comes up with the solution before the evidence (intuition) but is not seeking to

confirm the solution with evidence in the past, as that would negate the process of lateral

thinking. Lateral thinking is concerned with "the generating of new ideas and new

approaches, and with the escape from old ones. It is not a method for decision or for

action. Once the ideas have been generated, one has to satisfy oneself as to their









usefidness [his italics] before putting them into action" (p. 23). This appears to be very

similar to what occurs during clinical intuition, the generation of ideas outside of logical

thought when faced with uncertainty or feeling stuck with a client that are then checked

with the client without judgment as to "right or wrong."

According to Osbeck (1999), one may infer from the studies and way intuition is

described in such studies that there are three characteristics of intuition as a basis for

judgment. The first description is that intuition is unconscious processing (Osbeck, 1999).

The information received through intuition is implicit and from an unknown source.

Secondly, since this information influencing a decision is unconscious, intuition is

viewed as an inferential process, similar to the reasoning from a conscious process, but

operating at a level below awareness (Osbeck, 1999). Thirdly, information received

through intuition is frequently considered irrational. These characteristics lead to the way

intuition is viewed by psychological science: that there are two models of information

processing occurring, the cognitive system with its logic and reasoning and the intuitive

system with its automatic, creative and narrative style (Osbeck. 1999).

Intuition as Cognitive Bias in Decision-Making

Early cognitive psychologists examined intuition "as a basis for judgment in

problem solving" (Osbeck, 1999, p. 231). Osbeck (1999) describes the current interest in

intuition and its basis for judgment by comparing intuitive judgments to those formed by

more scientific methods. According to Osbeck, the results have so far been inconclusive.

Intuitive problem solving seems to be riddled with the same errors and biases in

judgments that formal hypotheses are (Osbeck, 1999). According to Osbeck, the studies

that have been done on intuition lead to two general conclusions: decisions from intuition









are less accurate than traditional reasoning and the accuracy improves with experience. In

addition to studying intuitive judgments, contemporary research has focused on decision-

making (intuition vs. analysis) and the impact of intuition on various fields (Osbeck,

I999).

Osbeck (1999) describes the studies on intuition as less accurate than logic. I

believe these studies are also biased against the use of intuition and thus reflect that bias

in their results. There is a general lack of many outcome studies on intuition. Further

outcome studies contradict Osbeck's conclusion by supporting the notion of intuition and

generally conclude that more qualitative and quantitative studies are needed.

As part of our information-processing systems. humans have developed strategies

to quickly process information and then quickly know how to act. These strategies (called

heuristics) have kept us alive and evolving, but are often associated with error in non-

fight-or-flight situations (Myers, 2002). When applying these heuristics in making

decisions, the strategies have associated biases, which can lead to incorrect conclusions

and assumptions. As intuition is described by many authors as part of information-

processing and decision-making, then it is also subject to the same errors as rational,

logical analysis. Many authors have commented on the links between intuition and

cognitive error/bias (Eisengart & Faiver, 1996; Gambril. 1990; Hall, 2002; Myers, 2002;

Osbeck, 1999; Tversky & Kahneman, 1974). Some of these errors in thinking include (a)

memory construction; (b) misreading our own minds: (c) mispredicting our own feelings

and behavior; (d) self-serving bias; (e) overconfidence bias; (f) hindsight bias; (g)

fundamental attribution error; (h) belief perseverance and confirmation bias; (i)

representativeness heuristic; (j) availability heuristic; (k) adjustment and anchoring; (1)









framing effect bias; (m) illusory correlation; (n) avoiding harm from acts of commission

than from acts of omission; (o) overlooking the normalcy of events; (p) socio-cultural

biases.

Each of these biases involves making incorrect assumptions based on faulty logic.

Belief perseverance and the confirmation bias are most closely involved with intuitive

decisions. Belief perseverance is the phenomenon that if we think our beliefs are correct,

then they tend to have a certain longevity despite evidence to the contrary (Gambril,

1990; Myers, 2002). The confirmation bias occurs when we form a belief. Humans tend

to search for evidence to confirm their beliefs, making cases for something that may be

incorrect. "On target" intuitions may actually be erroneous beliefs persevering despite

opposing evidence, as we hunt for evidence that confirms our intuitions.

In Gambril's (1990) C.ritical Thinking in Clinical Practice, she discusses in detail

the errors that may arise in cognition during work with a patient/client, trying to help

practitioners become more accurate and precise thinkers and thus, clinicians. Intuition

judgments were condemned as inaccurate judgments, erroneously believed to be correct

and with longevity that causes the clinician to seek evidence supporting the 'intuition'

(confirmation bias). However, throughout a book aimed at eliminating bias from clinical

decision-making. much of it is biased toward promoting logic and analysis as the only

valid critical thinking skills. By negating the use of intuition in clinical decision-making.

Gambril ignores what may be an entirely different information-processing system

operating, and may prove to be more accurate than logical/ analytical information-

processmng.








The literature linking intuition to cognitive bias does not intuitively nor logically

feel correct. The literature largely agrees that intuitive knowledge is from an unknown

source and therefore, not received through logical, analytical means (lateral thinking). If

this is the case, then biases and errors occurring in logical, analytical means (vertical

thinking) do not truly apply to the lateral, intuitive process. However, none of the authors

addressed the logical leap they made associating the cognitive errors/bias in logical and

analytical thinking with intuitive thinking. If the thinking systems are different, then the

biases and errors applying to one do not necessarily apply to another. Many positivist

authors dismiss intuition's use in decision-making by condemning it as illogical and full

of cognitive errors that arise from a different thinking process entirely. As vertical

(analytic) thinking is prone to such errors in judgment (and agreed upon in the literature),

why are the opponents of intuition not condemning analysis as so full of cognitive errors

that we should not use it?

Outcome Studies on Intuition and Business Decision-Making

Most of the literature on intuition in the business world describes the connection

between intuitive thinking and senior management/executives and entrepreneurs.

According to Shirley & Lagan-Fox (1996), intuition is becoming a highly valued skill in

the business world. Because intuitive processing and decision-making are highly valued

skills, there is an increasing amount of research in this area over the last fifteen years.

In what has become a landmark study in the field of intuition, Agor (1989)

studied over 200 executives' decisions. Agor (1989) found that "'good intuitive decisions

were, in part, based on input from facts and experience gained over the years, combined

and integrated with a well-honed sensitivity or openness to other, more unconscious









processes" (pp. 158-159). Furthermore, Agor's study "suggested that intuition is most

useful to managers in uncertain situations where they are faced with insufficient facts and

complex alternatives." (Clarke & Mackaness, 2001. p. 147).

Allinson, Chell, Hayes (2000) investigated if successful entrepreneurs are more

intuitive than managers, based on the unknown nature of starting a business. Using the

Cognitive Style Index (a questionnaire measuring intuition versus analysis), the authors

compared 156 replies from entrepreneurs with those of 546 managers from various

organizations. They found that successful entrepreneurs are more intuitive than general

population of junior & middle managers, but are similar in cognitive style to senior

managers. The authors adequately describe the limitations of their study as merely an

exploratory study and using a convenience sample. Despite these limitations, the study

was conducted with many attempts to control biases in the research process and was a

good empirical study. The authors state the need for further research in the area,

particularly since their hypotheses were supported by their data.

Clarke & Mackaness (2001 ) conducted a qualitative study of cognitive mapping

and the intuitive elements in cognitive decision making theory of executives. According

to the authors, cognitive mapping:

is a technique that has been used widely by management researchers in a
variety of different contexts to explore individual perceptual schema .
can be seen as a model of 'action-oriented thinking' about a situation in
which arrows signify influences in a line of argument linking cause and
effect. Such mapping makes comprehension transparent. The mapping
process involves respondents identifying factors affecting a particular
decision-making 'goal'. In case of strategic decisions, this can be some
measure of the effectiveness or quality of the decision itself (p. 1 52).

Despite all of the theoretical information given in the article, only four interviews were

done. Three of the interviews were conducted from managers within a single









organization, interviewing a fourth manager from outside the organization for a control

group. The authors found that senior managers were more intuitive (used more non-

factual information) than functional (lower-level) managers. The authors posited that

perhaps the differences were related to experience and not intuition, as their study

suggests. Although the authors analyzed the interviews and found general themes,

generalizability of their results must be viewed with caution due to the very small sample

size. Finally, the authors describe the study as an exploratory study with a small sample

and that more research is needed in this area.

Intuition, Expertise and Clinical Decision-Making

Clinical Intuition in Nursing

Numerous articles have been written on the importance of including intuition as a

valid part of clinical decision making in nursing. Many of the articles describe nurses'

experiences with intuition in their treatment and care of patients, the prevalence of

nurses' intuitive experiences with patients, and how it is a powerful diagnostic tool

(Benner, 1984/2001; Benner & Tanner, 1987; Brooks & Thomas, 1997; Buckingham &

Adams, 2000; Buckingham & Adams, 2000; Miller, 1993; Miller, 1995: Miller & Rew,

1989; Perry, 2000; Redding, 2001; Rew, 1986; Rew, 1987; Rew, 1988; Rew & Barrow,

1989; Ruth-Sahd, 1993: Thompson & Dowding, 2001; Welsh & Lyons, 2001). Because

of the growing acceptance of intuition in the nursing field, there are also an increasing

number of research studies to explore its connections to clinical skills.

Redding (2001) states that advanced critical thinking skills are needed in those

making clinical decisions. Critical thinking is "purposeful, self-regulatory judgment that

results in interpretation, analysis, evaluation, and inference, as well as explanation of the








evidential, conceptual, methodological, criteriological, or contextual considerations upon

which such judgment is based" (Redding, 1991, p. 57). From a nursing perspective,

Redding (1991) describes the critical thinking components involved in making clinical

judgments as a function of attitudes and dispositions; domain-specific knowledge;

cognitive skills and com~petencies; experience/practice; and intellectual and professional

standards.

From these five components, cognitive skills and competencies can vary as a

result of differing levels of cognitive development. Perry (1970) proposed a four stage

cognitive developmental model similar to Piaget's Model of Cognitive Development. The

first stage is dualism/received knowledge (black or white thinking, no questioning of

authority. typical of young children); the second stage is multiplicity/subj ective

knowledge (truth determined by internal and subjective means by incorporating diverse

opinions, typical of early and middle adolescence): the third stage is relativism/

procedural knowledge (self-confidence in truth-seeking, doubting, discerning what is

right and wrong by supportable evidence, typical of postsecondary education); the fourth

stage is commitment-in-relativism/constructed knowledge (personal choices of truth after

evaluating options, information received through intuition and other people, high

tolerance for ambiguity, only some achieve this stage).

Redding (2001) states that there are five subprocesses involved with critical

judgment, all of which use the last two stages of cognitive development, problem solving,

caring, unbiased inquiry (relativism); intuition and reflection-in-action (commitment-in-

relativism). Redding (2001) postulates that clinical decision-making is not possible

without reaching the relativism/procedural development stage and the last stage of








commitment-in-relativism/constructed knowledge allows the practitioner to go more in

depth with his/her decisions. Redding (2001 ) claims that caring is a function of empathy,

which forms the basis of the nurse's intuition and unbiased inquiry is the basis of

reflection-in-action (if in the final stage of cognitive development). Intuition, according

to Redding (2001), is "the ability to internally sense that a certain choice or decision is

contextually correct without necessarily being able to clearly describe how that sensation

is supported .. [and is] generally more accurate in the experienced nurse" (p. 62).

From Redding's (2001) descriptions of clinical judgment and cognitive

development, intuitive skills only develop in some practitioners, as a function of their

empathic skills and cognitive development leading to advanced critical thinking skills. As

clinical decision-making is similar in both nursing and counseling, one could infer that

the same applies for counseling intuition; i.e., it is a function of empathy and cognitive

development and indicative of advanced critical thinking skills.

Clinical Intuition Research in Nursing

Investigating the use of intuitive judgments in clinical assessments of mental

health nurses, Welsh and Lyons (2001, p. 299) defined intuitive judgment in clinical

assessment as "the ability to 'sense' when something is not as it appears to be." The

authors contend that intuitive judgments are part of Schain's (1983) concept of reflection-

in-action and that expertise involves a tacit knowledge base from which we draw intuitive

judgments. Welsh & Lyons (2001) conducted a qualitative case study/content analysis,

interviewing 8 staff nurses at a psychiatric assessment and short-term treatment center

about their clinical judgments regarding cases over a six-month period. The authors









hypothesized that nurses would rely on their formal and expert knowledge base (and thus

their intuition/tacit knowledge) when faced with complex patient issues, to aid risk

assessment and to develop treatment plans.

Three themes emerged from their content analysis: research evidence (formal

knowledge and its limitations), tacit knowledge (formal knowledge and expertise

combined), and advanced practitioner skills (a combination of tacit knowledge and

intuition). Welsh and Lyons (2001) concluded that in making clinical assessments, expert

nurses will 'sense' when the research evidence for a particular therapy is lacking or not

working, bypass linear thinking, and quickly link into his/her tacit knowledge base

accumulated through expertise, and accessed through intuition.

No study limitations were discussed in the article, but it appears that Welsh's and

Lyons' (2001 ) themes must be further studied as they might suffer from some of the

cognitive errors in logical analysis. In qualitative studies, the researchers are the research

instruments and it is apparent from their tone that Welsh and Lyons strongly believe in

the validity of intuition and tacit knowledge in making clinical decisions. Consequently,

without outside confirmation of their emergent themes (which was not discussed), Welsh

and Lyons could suffer from the confirmation bias, searching for evidence in the

interviews to support their hypothesis.

In landmark studies exploring intuition in the nursing, feld, Benner (1984/2001)

and Benner and Tanner (1987) found links between intuitive abilities, expertise, and level

of experience in nurses. Benner (1 984/2001 ) describes a five-stage model of skill

acquisition for nurses ranging from novice to expert where experts are more able to

recognize patterns from a variety of independent, distinct stimuli acting together to form









a whole. Benner (1984/2001) postulates that this pattern recognition may be what is

actually occurring with intuitive processes and tacit knowing in nurses' clinical

judgments. The concept of pattern recognition distinguishes the intuitive abilities of

expert nurses from beginners and implies intuition does not occur until nurses become

experts (Perry, 2000).

Additionally, Benner and Tanner (1987) describe the process of and how nurses

use clinical intuition in practice. From 21 interviews with expert nurses, Benner and

Tanner (1987) described six ways expert nurses use intuition: "pattern recogmition,

similarity recognition, commonsense understanding, skilled know-how, sense of salience,

and deliberate rationality" (p. 23). Pattern recognition allows an expert nurse to see

relationships between events or symptoms without knowing the specifics components of

a situation whereas similarity recognition is recognizing patterns from previous

experiences (and thus comparing how similar one pattern is to another). Commonsense

understanding is the skill involved with being so familiar with the language and culture of

the field that the nurse is able to pick up subtle cues that appear to go against common

sense but in reality, are correct indicators of subtle illness. Skilled know-how allows

nurses to rely on their deep understanding and the second-hand nature aspect of their

work to feel out the correct way to care for patients. When expert nurses can quickly sum

up various situations, distinguishing between serious and not serious patient

circumstances/illnesses, the nurse is said to have a sense of salience. Finally, deliberate

rationality is the expert nurse's ability to question rational assumptions and seek out

alternative explanations for a patient's circumstances when something does not appear to

be "right" (Benner & Tanner, 1987).








Contradicting Benner and Tanner's concept that only expert nurses use clinical

intuition is a study of undergraduate senior year nursing students by Brooks and Thomas

(1997). Conducting a descriptive, exploratory, qualitative study of structured interviews,

Brooks and Thomas (1997) investigated the decision-making processes of senior

undergraduate nursing students in a 'clinical' situation. Each student was given a clinical

vignette describing a patient. The nursing students were then interviewed as to how they

conceptualized and approached the patient and his treatment. Results suggest that all 18

students approached the vignette differently, citing several different intrapersonal

characteristics influencing decision-making (such as experience, personal values and

beliefs, culture and lifestyle, etc.). All students shared only one characteristic: all

responses perceived and judged the vignette through 'personal knowing' or

understanding the situation from the perspective of the subject's own unique self; the

student nurses knew what to do and knew what was expected, separate from their

education and experience. The concept of personal knowing is very similar to the

definition of intuition as an unconscious means of gaining information or knowledge.

Brooks and Thomas' (1997) study further suggests that even beginning student nurses

used intuition in their clinical decision-making, diagnoses, and treatments.

Clinical Intuition Research in Medicine

Despite the myriad articles in nursing supporting the use of intuition in clinical

situations, the medical literature has relatively f~ew articles promoting the use of intuitive

clinical decision-making. This is not surprising, considering the scientific, logical, and








rational emphasis in modern medicine. However, there is one study indicating that

doctors do use intuition in uncertain and potentially serious situations with patients

(Brennan, Somerset, Granier, Fahey, and Heyderman, 2003).

Brennan et al. (2003) conducted a qualitative study of how 26 general

practitioners diagnose and determine nebulous presenting symptomology in children with

possible meningitis. In reaching a diagnosis of meningitis (and/or septicemia), the doctors

discussed how they rarely see presenting cases of the disorders but knew that the

disorders seldom presented in a typical fashion. Being unfamiliar and uncertain with a

serious disease such as meningitis, Brennan et al. (2003) describe that the doctors "relied

upon intuitive rather than systematic methods to distinguish serious illnesses from those

that are self-limiting. Doctors frequently relied on gut feeling or intuition to identify

illnesses that are potentially serious" (p. 628). The doctors also reported, however, that

because of the non-systematic means of diagnosis, many doctors commented that they set

up "safety nets" (Brennan et al., 2003, p. 628) to cover themselves should their intuitive

judgments be incorrect. Finally, the participants in the Brennan et al. (2003) study

indicated that specific guidelines for diagnosis and treatment "depersonalize [sic] the

doctor-patient relationship, exclude intuitive methods of diagnosis and undervalue the

role of experience" (p.629).

There were several limitations of the current reported by Brennan et al. (2003):

potential researcher bias, miscategorization of data, and misinterpretation of themes.

However, these limitations are only limitations when examining a qualitative study with a

quantitative lens. Again, this de-valuing of qualitative methodology because it is "biased"

in an objectivist field like medicine is also representative of why intuitive clinical









decisions are not openly trusted. From all research, there is always the potential for

researcher bias; in qualitative research, these biases are acknowledged, made explicit and

attempts are made to keep the bias from affecting the analyses.

In the Brennan et al. (2003) study, there are some limitations from a purely

qualitative perspective. Brennan et al (2003) did not specifically state their biases, as is

the norm in qualitative research, to allow the reader to judge the trustworthiness of the

conclusions. As such, this exclusion is a limitation of the research. One final limitation of

the study is that no specific analysis method is discussed. Brennan et al. (2003) discuss

doing interviews and finding themes, but good qualitative research is explicit about the

ontology, epistemology, methodology, and methods used to collect and analyze data

(Crotty, 2003).

Clinical Intuition and Emotional Recognition

Counselors work with peoples' emotions and identifying these emotions is one of

the primary requirements for good counseling. As humans, we constantly read other

people's emotions and thus are usually quite good at distinguishing between various

emotional states. Does this emotional recognition improve with training and education?

Although there is no specific literature on intuitive emotional recognition in counseling,

there was one study examining how naive coders with no training compare with trained

coders in determining different emotional expressions (Waldinger, Schulz, Hauser, Allen

and Crowell, 2004).

Waldinger et al. (2004) investigated the prediction of emotions and marital

satisfaction between married couples' emotional expression. A third hypothesis examined

how naive, untrained coders of the couples' emotions compared to specifically trained








coders (following a detailed rubric) of emotions. Waldinger et al. (2004) believed that

nalve coders would identify similar emotions as those with a guideline and training

because identifying emotional cues in innate and intuitive in nature. As a result,

Waldinger et al. (2004) postulated that the intuitive nature of reading emotions would

enable the nalve coders to be as or more productive in distinguishing emotions than the

trained coders who must follow specific guidelines (and thus, ignore their intuitions).

Results indicated that nalve coders were consistent with the trained coders in identifying

emotions and that the nalve coders picked up emotional intensity more frequently than

did the trained coders (Waldinger et al., 2004).

One limitation of the Waldinger et al. (2004) study is that they used a relatively

small sample size for a factor analysis (N=47). Because of the small sample size, results

must be viewed with caution and more studies are needed to determine the reliability of

results. Despite this limitation, the results do indicate that the act of reading emotions is

intuitive by our human nature (Waldinger et al., 2004) and may therefore indicate how

some counselors use intuition in clinical decision-making.














CHAPTER 3
METHOD

Brief Explanation of Grounded Theory

Before I discuss the specific elements of the methods in my study, I would like to

give you an overview of grounded theory analysis. I outline how I plan to specifically

apply grounded theory in my study following this brief explanation of the important

components of grounded theory.

Grounded Theory

All grounded theory data collection and analysis is fueled by the constant

comparative method (Glaser & Strauss, I967), which Strauss and Corbin (1998) later call

comparative analysis, an analytical tool. With this method of microanalysis, the

researcher continually makes theoretical comparisons between and within data, incidents,

indicators, contexts, concepts, codes, and categories to delineate the processes,

dimensions, properties, and variations of each under different conditions (i.e., the

different participants' experiences) (Charmaz, 1983; Glaser & Strauss, 1967; Strauss,

1987; Strauss & Corbin, 1998). Constant comparisons are done at all levels of coding and

analysis (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978;

Glaser & Strauss, I967; Strauss, 1987).

Comparative analysis/the constant comparative method does not merely describe

the different dimensions or properties of the developing concepts and categories; it also

analyzes the similarities and differences within and between concepts and categories









(Charmaz, 2000; Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin, 1998). Glaser

and Strauss (1967) discuss the comparing of incident to incident; i.e., comparing the

dimensions and properties of each incident to one another to elucidate the categories and

theory. Strauss and Corbin (1998) elaborate with the idea of theoretical comparisons.

According to Strauss and Corbin (1998), "we not only speak of comparing incident to

incident to classify them, but we also make use of what we call theoretical comparisons

[their italics] to stimulate our thinking about properties and dimensions and to direct our

theoretical sampling" (p. 78).

Theoretical comparisons use the similarities, differences, and/or varying degrees

of the incidents' properties as tools to better understand the data (Strauss & Corbin,

1998). For example, if I want to initially interview three counselors, then I will compare

and contrast my participants, letting the data guide the comparisons. Furthering the

example, if level of experience emerges as an important component for counselors to

construct meaning of the clinical intuition, I can then group my participants into two

categories: experienced counselors and inexperienced counselors. I would theoretically

compare them by examining what it means to be experienced or inexperienced, how

counselors think/act/counsel when inexperienced or experienced, etc. and then compare

the "answers" from each category to each other to further the theory construction and

further coding.

Theoretical Sampling

In qualitative research, participants are be recruited through purposeful, selective

sampling (Glesne. 1999; Kuzel, 1999). The different, specific qualitative methodologies

or methods sample purposefully using different procedures. Sampling in grounded theory









is guided by the emerging categories and themes in a process called theoretical sampling

(Charmaz. 1983; Charmaz, 1995; Charmaz, 2000;Charmaz, 2001; Glaser, 1978; Glaser &

Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Specifically, Strauss and Corbin

(1998) define theoretical sampling as:

Data gathering driven by concepts derived from the evolving theory and
based on the concept of 'making comparisons.' whose purpose is to go to
places, people, or events that will maximize opportunities to discover
variations among concepts and to densify categories in terms of their
properties and dimensions. (p. 201)

Theoretical sampling is flexible and is therefore not rigidly determined before

beginning the research to allow for maximum comparisons between concepts that emerge

from the analysis and to encourage creativity (Charmaz, 1983; Charmaz, 1995; Charmaz,

2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss &

Corbin, 1998). As a result, criteria for selecting participants will change with emerging

categories and interview questions will become more refined with each interview.

According to Strauss and Corbin (1998), "theoretical sampling is cumulative. Each event

sampled builds from and adds to previous data collection and analysis" (p. 203).

Although there is no rigidly followed procedure for recruiting participants in

theoretical sampling, it is also not a haphazard process of sampling anyone or anything

until the researcher whimsically decides to end his or her sampling procedure. In

grounded theory, sampling and analysis must occur simultaneously until no new

information emerges, a point called theoretical saturation (Charmaz, 1983; Charmaz,

1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss,

1987; Strauss & Corbin, 1998). Theoretical sampling must be consistent and systematic

to ensure that the data analysis and comparisons made are focusing the developing








theory. Initially, theoretical sampling gives the researcher a starting point; consequently,

the initial sample and interviews will be guided by several considerations. Strauss and

Corbin (1998) state that:

The initial decisions made about a project give the researcher a sense of
direction and a place from which to launch data gathering. What happens
once data collection is underway becomes a matter or how well the initial
decisions fit the reality of the data. Initial considerations include the
following: 1. A site or group to study must be chosen. .. 2. A decision
must be madet about the types of dalta to be used. .. 3. Another
consideration is howI long an area should be studied. .. -1. Initially,,
decisions regarding the number ofsite~s anrd observations and/or
interviews depend on access, available resources, researrch goals, and the
r~esearrcher 's time schedule andu energyi. [their italics] (p. 204)

Stages of Coding and Sampling

Grounded theory's analytic procedures can be useful to many different research

questions and different perspectives by building theories that allow the data to speak

(Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001). There are three main

phases of coding in grounded theory analysis: open, axial, and selective (Glaser, 1978;

Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Charmaz (1983; 1995;

2000; 2001) names the phases initial and focused coding, generally integrating axial

coding into the end of initial coding and into the beginning of focused coding. Each phase

has specific goals and is aimed at developing the emerging themes, processes,

relationships (between and within), dimensions, and properties of the theory to different

degrees. The purpose of theoretical sampling techniques differ as the coding becomes

more focused; starting out as open sampling in open coding, moving to relational and

variational sampling during axial coding, and ending with discriminate sampling in

selective coding (Strauss & Corbin, 1998).








Open coding and open sampling. In open coding, the researcher is interested in

starting to ground the data by broadly coding each data source, going line-by-line and

constantly comparing the basic codes and properties of the codes with each other to

discover concepts and categories (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001;

Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). According

to Strauss and Corbin (1998), during open coding, transcript data are "'broken down into

discrete parts, closely examined, and compared for similarities and differences. Events,

happenings, objects, and actions/interactions that are found to be conceptually similar in

nature or related in meaning are grouped together under more abstract concepts termed

'categories."' (p. 102).

After fully open-coding the transcript, you then group the open codes/categories

by the nature of their relationships and by forming hypotheses (axial coding). In axial

coding, the researcher further elaborates the dimensions, variations, processes,

relationships (between and within), and properties of each category by constantly

comparing more focused, incoming data to existing data to begin to see a broader theory.

At the beginning of a study, sampling is open (as is the coding) in that a

researcher is trying to maximize variation and information from the data and participants;

therefore, when sampling, a researcher in open coding may choose sites and participants

that will thus maximize variation and information. Since there are no developing

concepts, a researcher may use the existing field literature and/or her/his intuition to

guide participant selection (Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin,

1998).








Axial coding and relational/variational sampling. As data collection continues

(with immediate data analysis), concepts begin to emerge that guide the next sampling

procedures. During the next phase of coding, axial coding, the researcher is trying to

make connections between and within emerging categories to specify the categories'

dimensions, properties, and ranges (Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987:

Strauss & Corbin, 1998). Strauss and Corbin (1998) define axial coding as "'the process

of relating categories to their subcategories, termed 'axial' because coding occurs around

the axis of a category, linking categories at the level of properties and dimensions" (p.

123). During axial coding, the researcher is concerned with examining the phenomenon

of study's structure (context) and process (actions/interaction over time and their

consequences) (Charmaz, 2001; Strauss & Corbin, 1998).

As a result, theoretical sampling at this stage involves the researcher sampling

participants or previously collected data who/that will give rich data about "incidents and

events .. that enable him or her to identify significant variations .. [by] comparing

incidents and events in terms of how these give density and variation to the concepts to

which they relate" (Strauss & Corbin, 1998, p. 210-211). This comparison is best done by

maximizing similarities and differences between participants and is done using intuition,

knowledge of participants, or persistence until the concepts emerge.

Selective coding and discriminate sampling. Finally, in selective coding, the

axial codes are grouped together into one "theoretical structure that enables us to form

new explanations about the nature of the phenomena."' (Strauss & Corbin, 1998, p. 103).

The goal of selective coding is to incorporate all of the categories' /concepts' dimensions,

properties, and relationships (between and within) to develop a cohesive theory and to









find where any holes in the theory might be. The data is rigorously compared with each

other and with very focused, incoming data to build a cohesive theory that is validated by

further data collection and constant comparison (Charmaz, 1983; Charmaz, 1995;

Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin,

1998).

Discriminate sampling, which occurs in selective coding is therefore, "highly

selective .. deliberate [sampling] .. that will maximize opportunities for comparative

analysis" (Strauss & Corbin, 1998, p. 21 1). During this phase of coding and sampling, the

researcher is rigorously and constantly comparing new incoming data to the current

data/theory and seeking new information when final validation or illumination is

necessary to reach theoretical saturation.

Theoretical Saturation

When further theoretical sampling, data collection, and data analysis fail to yield

any new theoretically relevant information, the researcher has reached theoretical

saturation and can stop further sampling, data collection, and analysis (Charmaz, 1983;

Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967;

Higginbottom, 2004; Strauss, 1987; Strauss & Corbin, 1998). According to Strauss and

Corbin (1998). "Saturation is more a matter or reaching the point in the research where

collecting additional data seems counterproductive; the 'new' that is uncovered does not

add that much more to the explanation at this time"' (p. 136).

Theoretical Memos

Theoretical memos in grounded theory are analytic reflections by the researcher

related to the data, codes, and the developing theory (Charmaz, 1983; Charmaz, 1995;








Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987;

Strauss & Corbin, 1998). Theoretical memos are the flesh and blood of grounded theory

analysis; they are where the analysis actually takes place. Theoretical memos are not

written to describe the data; they are written to analyze the data. (Glaser, 1978; Strauss &

Corbin, 1998). Theoretical memos force the researcher to focus on the data to help

develop the emerging concepts (Glaser, 1978). According to Glaser (1978):

The core stage [his italics] in the process of generating theory, the
bedrock of theory generation, its true product is the writing of theoretical
memos. If the analyst skips this step .. he [sic] is not [his italics] doing
grounded theory. Memos are the theorizing write-up of ideas about codes
and their relationships as they strike the analyst while coding [his italics].
(p. 83).

Theoretical memos have four purposes/goals: working with ideas, allowing

freedom of thought, developing a memo bank, and easy sorting of the memo back

(Glaser, 1978). All researchers should write memos to conceptualize theoretical ideas

from the data, expand the properties of concepts and categories, present ideas about the

relationships between and within categories, integrate the different ideas/categories, and

compare the developing theory with already existing theories (Glaser, 1978). When

writing memos, researchers should keep an open mind and not judge what they are

writing to keep the ideas flowing (Glaser, 1978). Once memos are written, they should be

organized in an easily retrievable system that can be easily sorted into new arrangements

to aid with analysis (Glaser, 1978). Since memos are about the constant comparison of

the data's concepts and categories, they can also serve to direct theoretical sampling and

develop sensitivity to the data (Glaser, 1978)









Purpose of the Current Study

The purpose of this study is to better define and understand how counselors make

meaning and how counselors use that meaning of their clinical intuitions to help clients

by developing a preliminary theory of its use in counseling through a series of semi-

structured interviews with counselors (i.e., mental health counselors, marriage and family

therapists, school counselors, and counseling psychologists) that were analyzed using

grounded theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser

& Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998).

Despite the many divergent views of intuition and clinical intuition, there are

relatively few empirical studies discussing clinical intuition specifically in counseling. I

hope to better understand how counselors construct knowledge about their clients using

clinical intuition. I am investigating two main research questions based on the process

and meaning of clinically intuitive thought in counselors:

(1) How do counselors construct meaning of their clinical intuitions about clients?

(2) How do counselors use the constructed clinical intuitions to help their clients?

My study is exploratory, aimed at building an initial theory of clinical intuition in

counseling that is grounded in data. Ultimately, this study is one step in a longer

process of developing a thorough and broad theory of intuition in psychotherapy.

Theoretical Perspective Constructivism

Constructivism is the epistemological view that an individual constructs

knowledge and the meaning of reality through her or his individual mind (Crotty, 2003).

It is separate from social constructionism (social constructionism holds that meaning

making is an act of co-construction through interaction with another person or the









environment) in that constructivists hold that an individual constructs meaning through

his or her own mind (Crotty, 2003). Constructivism allows for flexible interpretations of

truth and knowledge that will differ according to the perceptions/meaning-

making/experiences of individual minds (Charmaz, 2000).

According to Schwandt (1994), constructivism is concerned with the first-hand

experiences of participants and is based on the idea that "what we take to be objective

knowledge and truth is the result of perspective. Knowledge and truth are created, not

discovered." (p. 125). Despite the relativist nature of constructivism, Schwandt (1 994)

posits that you can be a realist somewhat while still being constructivist in that

constructivists sometimes believe in an objective real world where ideas and concepts are

invented/constructed to correspond to something in said real world.

Guba and Lincoln (1994) state that constructivist inquiry is: (a) ontologically

relativist in that there are multiple realities that are the products of our individual minds;

(b) epistemologically transactional and subjectivist in that the researcher and object of

investigation co-create the findings together in transaction; and (c) is methodologically

hermeneutic and dialectical in that the "'individual constructions can be elicited between

and among [their italics] investigator and respondents" (p. 1 11) that are then

discussed/analyzed through comparison and contrasting to "`distill a consensus

construction that is more informed and sophisticated than any of the predecessor

constructions"' (p. 111). Constructivist inquiry is evaluated by how well the constructions

"'~fit' with the data and the information they encompass; the extent to which they 'work,'

that is, provide a credible level of understanding; and the extent to which they have

'relevance' and are modifiablee'" (Guba & Lincoln, 1989, p. 179).








As constructivism is theoretically concerned with the individual construction of

meaning and knowledge, I explored how individual counselors make meaning out of

clinical intuition. Clinical intuition is outside reason by its nature but worth

systematically studying to further our construction of knowledge. Because clinical

intuition is not fully described or understood, I worked within the constructivist

perspective to better describe counselors' perceptions of clinical intuition in counseling

based on the two research questions above. I used a constructivist theoretical framework

while conducting my research, hoping to fully describe and bring unity to the many

divergent experiences of clinical intuition.

Grounded Theory & Epistemological Consistency

The study's theoretical framework comes from constructivism (Charmaz, 2000;

Crotty, 2003; Lincoln & Guba, 1994b; Schwandt, 1994) and I used grounded theory

analysis techniques (Charmaz, 1983; Charmaz, 1995: Charmaz, 2000; Charmaz, 2001;

Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Grounded

theory is epistemologically ambiguous to me. The original purpose of grounded theory

was to develop generalizable theory that is grounded in data using very systematic data

collection and analysis procedures (Charmaz, 2000). As a result, grounded theory is

rooted in positivism.

The most recent descriptions of grounded theory tend to describe the analysis in

more constructivist terms (Charmaz, 2000; Charmaz, 2001: Strauss & Corbin, 1998) and

that grounded theory methods appear to be compatible with constructivist inquiry

(Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Guba & Lincoln,

1989). The reflexive search for a common consensus of individual constructions that









describes the data better than any one alone seems very similar to the coding/analytical

process in grounded theory (Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin,

1998). Although grounded theory methods appear to be more positivist than other

qualitative methods (Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998), its

adaptation to constructivist inquiry make it a suitable match for a constructivist

epistemology.

The epistemological confusion creates methodological difficulties for me as the

researcher. I tend to be much more constructivist when approaching knowledge and

inquiry. I also like the specific, proscribed nature of the techniques in grounded theory. If

1, as a constructivist, use an analysis method with positivist roots (grounded theory), will

my study be epistemologically consistent? I believe that because my roots as researcher

are constructivist, then I cannot help but apply the method in a constructivist fashion.

Grounded theory gives me tools and techniques during my analysis; however, my

analysis (as I am constructivist) ultimately has a constructivist flavor.

For my study, constructivist grounded theory is an appropriate analytic method

for several reasons. First, as I studied a non-rational topic like intuition, I believe having a

proscribed yet flexible set of procedures for data collection and analysis adds some

needed structure to the study. Secondly, using constructivist grounded theory allowed me

to construct themes and meanings while my participants constructed their own personal

meanings of clinical intuition while maintaining the structure that facilitated the analysis.

Finally, as I am intuitive and studying clinical intuition, using constructivist grounded

theory simply felt intuitively right to me.









Using grounded theory methods such as conducting interviews, theoretical

sampling, constant comparison, various coding strategies, and by writing theoretical

memos for my data collection and data analysis, I constructed a theory describing the

meaning of clinical intuition for my participants.

Data Collection

Sampling

Initial theoretical samplinglopen sampling. I initially theoretically sampled and

recruited participants through criterion sampling (Kuzel, 1999). Criterion sampling

involves selecting participants that all meet some outlined criteria. As I am studying the

intuitive experiences of counselors (general psychotherapists). all participants met the

criteria of typical professional counselors/therapists: (a) are in the counseling field in

training, practice, or academia; (b) all participants held at least bachelor degrees and are

pursuing or have received advanced degrees in a counseling field; (c) all primarily

conduct relationship-based clinical practice; (d) all have had strong or frequent

experiences of intuition in counseling; and (e) are diverse according to years of

counseling experience.

With participants who met all of the criteria, then I used the existing nursing

literature on clinical intuition and expertise as an additional criterion, to begin my sample

by interviewing, counselors with different levels of experience. I purposefully chose

intuitive counselors with varying years of experience (novices with 0-5 years

experience, intermediate counselors with 5-15 years experience, and experts with 15+

years experience) to set an initial foundation for theoretical sampling. I started by

interviewing one novice, one intermediate, and one expert counselor. I hoped to interview









a diverse sample in regards to gender, race, age, ethnicity, sexual orientation, and

disability but ended up with a fairly homogenous sample consisting of five white

participants, four of whom were female and one male. Based on the emerging themes, I

then sampled according to where the data pointed me by seeking information-rich cases.

To find information-rich cases, I used my insider knowledge of the participants'

degree programs, various students'/graduates' experiences in it, and the local counseling

community to choose participants whom I felt had a lot to say regarding my research

questions. Additionally, to further identify my subgroup of intuitive counselors, I asked

several faculty members in the University of Florida, Department of Counselor Education

and the University of Florida Counseling Center to identify several intuitive counselors or

intuitive counselors-in-training in the community, department, or state with varying

degrees of counseling experience.

In an attempt to further increase the diversity of my sample, I also recruited

participants through emails sent to counseling listserys asking those who self`-identify as

intuitive counselors to participate in my study. To determine the appropriateness of each

other-identified or self-identified intuitive counselor, I asked her/him to tell me a brief

description of how he/she regularly uses intuition in her/his counseling. I selected only

those self-identified intuitive counselors if they met the criteria above, if they appeared to

be information-rich cases based on their brief descriptions, and if they increased the

diversity of my sample.

Focused, relational/variational, and discriminate theoretical sampling. As

themes emerged, I sampled participants according to areas of my emerging

categories/theory that needed further elaboration, clarification, or explanation until no








new information emerged and I reached theoretical saturation (Charmaz, 1983; Charmaz.

1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Kuzel, 1999; Strauss, 1987:

Strauss & Corbin, 1998).

I felt two participants in my initial sample were information-rich cases for the

categories I was trying to elucidate and contacted them for one further interview each

(Woody and Katie). I needed new participants to illuminate my emerging themes and

recruited new participants primarily through asking counseling faculty for counselors or

counselors-in-training who would elucidate my emerging themes. One new participant

volunteered for the study and was from a different educational background, so I included

her in my sample (Jera). I interviewed one of the private practitioners (Molly) suggested

by a counselor education professor and found my data saturating after her interview.

After a result, no further sampling occurred.

Participants

My total sample included five interviewees (two participants were interviewed

twice and three were interviewed once), as determined by when I reached theoretical

saturation (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser &

Strauss, 1967; Kuzel, 1999; Strauss, 1987; Strauss & Corbin, 1998). The exact number of

interviews and interviewees was decided during the data collection and data analysis

process, when I felt that further sampling was not necessary based on the saturation of

data.

Interviewing counselors with varying degrees of counseling experience (0-5 yrs,

5-15 yrs, 15+t yrs experience), the participants held bachelor's degrees to doctorates and

ranged in age from 30 years to 80 years. I attempted to initially interview people with









different demographic information but the diversity I sought ended up primarily as

diversity of training and years of experience. To protect my participants' anonymity. I

asked all participants to choose a pseudonym (Woody, Katie, Jera, & Molly) and gave a

pseudonym to one participant who could not come up with one (Alice). I asked my

participants if they would prefer I kept some of their non-essential demographic data

confidential by broadening terms when reporting their data. No one clearly indicated that

they preferred me to change identifying information; however, if I felt that something

would identify my participant, I changed the non-essential information (such as places of

work and distinct, named experiences in the community).

Woody is a 34 year old, white male, PhD candidate in a Counselor Education

program at a large Southeastern United States university. His specialty track is school

counseling. Woody has a total of 6 to 7 years experience counseling, both in full-time

work and during his master's and PhD training. Woody is currently working as a

counselor in a university counseling setting. I conducted one initial and one follow-up

interview with Woody. Woody was the first participant I interviewed and as I collected

more data, I wanted to investigate how his experiences matched my newly emergent

codes. Consequently, I interviewed him again four months after our initial interview.

Katie is a 54 year old white female counselor holding a doctorate in Counselor

Education (specializing in mental health counseling) from a large university in the

Southeastern United States. Katie has a total of 15 to 17 years counseling, including her

years prior to going back for her doctorate. Katie is currently seeing clients in a private

practice. I conducted one initial and one follow-up interview with Katie. She was my

second participant and like with Woody, as I collected more data, I wanted to investigate









how her experiences matched my newly emergent codes. Consequently, I interviewed her

again five months after our initial interview.

Alice is a 33 year old white female student in an MEd/EdS program in Counselor

Education at a large university in the Southeastern United States. She is currently in her

second year of coursework, is specializing in mental health counseling and has a total of

1.5 years experience in counseling. I conducted one initial interview with Alice.

Jera is a 30 year old white female PhD candidate in a Counseling Psychology

program at a large Southeastern United States university. She is currently working on her

dissertation and completing her APA-approved internship. Jera has a total of 5 to 6 years

counseling experience. I conducted one initial interview with Jera.

Molly is an 80 year old white female counselor holding a doctorate in Counselor

Education from a large university in the Southeastern United States. Molly has a total of

30 +t years of counseling experience. Molly has a private counseling practice and directs a

training program for counselors in specific theoretical applications of counseling. I

conducted one initial interview with Molly.

Data Collection Procedure/Interviews

I initially conducted three (one novice counselor, one intermediate counselor, and

one expert counselor) individual, semi-structured interviews with my participants in

private locations within their academic departments or their offices. I explained that our

conversations will be audio-taped but they were free at any time to turn off the tape and

stop recording. I described the nature of the study to each participant and gave them the

informed consents to read and sign. I also informed each participant that this study is for

my dissertation and it will be presented and potentially published. There were eight initial









interview questions, with flexibility to probe for more information, should the need arise

(please see Appendix A). As categories emerged during simultaneous analysis, the

interview questions changed in the direction of the data, making a total of 1 1 initial

interview questions (please see Appendix B) for new interviewees (Jera & Molly) and 5

follow-up questions for those two participants (please see Appendix C) I met with again

(Woody & Katie). Each interview lasted between 35-90 minutes.

After completing each interview, I transcribed the interviews from the audiotapes.

After each interview and throughout the analysis procedure, I made reflective notes and

theoretical memos about my reactions to the interviews, comments/questions that arose

for me, and my thoughts/ideas about the data analysis procedures and content. As my

study is based on developing and grounding a theory from data, interview questions

evolved during the research process. Analysis of data occurred throughout the data

collection process, going more in-depth with interview questions and emerging themes.

Participants indicated that the interviews were helpful for them to put their

clinical intuition, which they usually do not think about, into words. All interviews went

well, although there were times when I felt that I was not asking questions in a way to get

at the information. Occasionally, I had reactions to the data, agreeing with what the

participants stated or having it trigger some negative reaction in me. When those

emotional reactions occurred for me, I wrote about them and worked through them by

writing memos.

Validity and Reliability

There is debate regarding validity and reliability in qualitative research.

Traditionally, positivist and empiricist research tends to evaluate the rigor of a study









through examining its reliability and validity (Kirk & Miller, 1986). In positivism, if we

measure something consistently and get the same results (reliability), then we can feel

more confident that we are getting close to the true nature of the phenomenon (Kirk &

Miller, 1986). Furthermore, if we have high validity, then we can feel confident that we

are measuring the actual true nature of a phenomenon (Kirk & Miller, 1986).

Since qualitative research tends to move away from the positivist epistemology of

holding that there is an absolute truth that we can objectively measure and evaluate, then

using the positivist measures of good scholarship and science do not fit well with these

different epistemologies in qualitative research (Angen, 2000; Denzin & Lincoln, 1994a;

Giorgi, 2002; Kirk & Miller, 1986; Lincoln & Denzin, 2000). Qualitative researchers are

re-defining how to assess rigor in qualitative research with its unique characteristics

(Angen, 2000; Giorgi, 2002; Kirk & Miller, 1986; Lincoln & Denzin, 2000). Depending

on the epistemology used by the researcher, these methods of insuring rigor can vary

(Angen, 2000; Giorgi, 2002; Lincoln & Denzin, 2000) but ultimately are there to try and

bring voice to the participants' stories and that the writing was not solely the author's

biased interpretation (Richardson, 2000).

Instead of using the terms reliability and validity, qualitative researchers discuss

rigor in different terms like trustworthiness (whether we as readers can trust the

researcher' s interpretations of their participants' voices) and credibility (whether we as

readers find the researchers' conclusions reasonable) (Angen, 2000). To help readers trust

and find results credible, different researchers are going to take different approaches

(Giorgi, 2002; Denzin & Lincoln, 1994a). For example, some authors recommend

triangulating data, which is a method aimed at using different ways to locate the data by









coming at it from multiple points of view, to increase trustworthiness and credibility in a

study (Denzin, 1978, Glesne, 1999; Lincoln & Guba, 1985). Others recommend stating

your subjectivities in your writing, using your writing as an additional method of inquiry,

keeping a strict audit trail, member checking, writing theoretical memos to increase the

rigor of a study (Denzin & Lincoln, 2000; Glaser, 1978; Glesne, 1999; Richardson, 2000;

Strauss & Corbin, 1998).

In my study, from a constructivist viewpoint, I do not believe we can truly be

objective since there is no absolute truth or knowledge. However, I still attempted to best

represent my participants' constructions of clinical intuition in counseling by using a

variety of methods to ensure that I was accurately representing their voices in my

analysis.

To do so, I chose counselors from multiple sites (triangulation), wrote and

analyzed my theoretical notes/memos/journal from my observations and consistently

reflected upon my biases as a researcher, conducted more than one interview with some

participants. asking several peers to "'audit" my coding strategies, themes, and transcripts.

I also kept a strict paper trail of information regarding when I met with my participants,

how I reacted to their interviews, my analytical memos, and how I transcribed their data.

Finally, I gave my transcripts to and discussed preliminary results with my participants,

trying to ensure that their voices were accurately represented.

Data Analysis

Theoretical Memo Writing

At each stage of coding and analysis, I wrote theoretical memos. My theoretical

memos became more focused on theory and comparisons of the data throughout the









analysis. Initially, I wrote memos about working through confusion or uncertainty,

extracting meaning from the data, and putting my thoughts together to form concepts and

categories. In axial coding, my theoretical memos focused more on the process,

dimensions, and relationships within and between categories (looking at the contexts,

actions/interactions, and consequences of the different concepts). During selective

coding, I wrote memos aimed at clarifying and illuminating gaps in my developing

theory, working out final confusion or uncertainty, and the constant comparisons between

my very focused incoming data with my theory.

Open Coding

I initially open coded each transcript broadly by underlining and coding phrases

that describe the participants' experiences with intuition. I then open coded the transcripts

more specifically, constantly comparing phrases that frequently repeated, jumped out at

me, were common to more than one transcript, or were different across the transcripts

(constant comparison method). While open coding, I underlined, wrote in the margins of

the transcripts, and developed code lists of words or phrases of interest. Some initial open

codes were: Sense of Knowing; Usually Right; Thought; Vision; Speeds Up the Process

(in vivo code); Not Judgmental; Helps Client Feel Understood; Trust Intuition More; and

Subtle Sharing of Intuition.

Axial Coding

Once I completed open coding (through my reflexive notes, theoretical memos,

and the constant comparative method), several axial codes (themes and/or categories)

emerged that began to describe and integrate the data. The axial codes that described the

data were: Sense of Knowing/Connection/Awareness; Spontaneity of Intuition; Using








Tentative Phrasing; Using Respectful Phrasing; Checking Out Intuition; Comfort in

Being Wrong; Belief that Intuition is Right; Therapeutic Change; Recognized in the

Moment; Recognized after the Session; Receiving Intuition in Different Modes; Positive

Attitude of Counselor; Negative Clients: Expression of Intuition: Strength of

Relationship with Client; Quality of Relationship with Client; Increased Confidence with

Experience; Trust of Intuition with Experience; Rapport; and Being Fully Present. Using

different color highlighters denoting each of the above axial codes, I then went back

through the transcripts highlighting words and/or phrases that fell into the separate

categories. I also grouped the open codes from my separate code lists into each of the

axial code categories.

I continued to write analytical memos during this stage of analysis to further

develop the emerging categories from new data collection. My memos in axial coding

were much more theoretical than the beginning open coding memos (please see Appendix

D). As the data began to frequently repeat, I was eliminated some axial codes and

proceeded to the next stage of analysis.

Selective Coding

Continuing to write memos, during selective coding, I further refined and

synthesized the axial codes. The codes that appeared most frequently and were at the core

of how counselors make and use meaning of clinical intuition in counseling became my

selective codes: Recognizing & Receiving the Intuition: Sense of Knowing or

Awareness; Tentative and Respectful Expression of Intuition: The Counseling

Relationship; and Therapeutic Change.









From these selective codes, I integrated them into a core category (which became

my theory statement) that best described how counselors use and make meaning of

intuition in counseling. I then verified my emergent theory by constantly comparing the

theory with old data and newly collected data to fill in the theory's gaps. When no new

information emerged during my first interview with my fifth interviewee (Molly), I

completed my analysis and developed a theory figure to offer a visual representation of

the results.















CHAPTER 4
FINDINGS


The theory that developed from my data analysis is: Counselors construct

meaning of clinical intuition as a sense of knowing or awareness about clients, resulting

from the counseling relationship, that they then communicate to the client, benefiting the

counseling process. The theory incorporates elements of defining what intuition is and

how the counselors receive or recognize it as intuition, the importance and cyclical nature

of the counseling relationship in generating clinical intuition, how counselors

communicate the intuitions to their clients, and also the boundaries and benefits of using

clinical intuition.

Figure 1 illustrates the important elements of the theory in context with each

other. The three central elements to the theory are the client. the counselor, and the

intuition, which are all connected by the counseling relationship. If a client is too

negative, too unhealthy, or not available to the counseling process, then a boundary from

the client's side keeps the relationship from truly forming and thus does not generate

clinical intuition for the counselor. Likewise, if a counselor has a negative emotional

reaction to a client, then a boundary from the counselor's side keeps the relationship from

truly forming and thus does not generate clinical intuition for the counselor. If these

boundaries do not occur in session, then a sense of rapport, a sense of connection and a

sense of presence with the client help create a positive counseling relationship, which

helps generate intuitions for the counselor.






















Boundary to Process
Negative
Emotional Reaction
ion to Client


Bound r o
Process Cl
not available


Boundary to Process
Cl too 'unhealthv'


B undaryt
Process Cl
too negative


Figure 1. Theoretical Model of Clinical Intuition In Counseling


Rapport









A counselor's level of experience influences how they trust using intuition in a

session which also impacts how comfortable they are receiving and recognizing the

intuition. After trusting, recognizing, and receiving the intuition through a variety of

ways, the counselor usually believes that the clinical intuition is correct, thus giving them

a sense that they are right. Concerned about the relationship, the counselor will

communicate the intuition in a tentative and respectful way, giving the client safety to

disagree, and also are willing to be proven wrong. This way of communicating the

intuition improves the counseling relationship, thus creating more opportunities for

clinical intuition in the counselor.

After communicating the intuition, the benefits of intuition can then start creating

positive change for the client. Usually these benefits help the client gain meaning from

the intuition, create a turning point for the client, and/or speed up the counseling process.

All of these benefits help move the client toward therapeutic change, ultimately

impacting the outcome of therapy in a positive way.

Defining Clinical Intuition

All participants referred to intuition in counseling as either a sense of knowing

(Katie, Alice, Jera) or an awareness (Woody, Molly) that they recognize as being relevant

to the client but without knowing how they know the information. Despite the intangible

nature of the sense of knowing, all participants indicated that when they recognized the

intuition as for their client, it was nearly always correct or on target when they followed

up on the insight with the client. Furthermore, although all participants trusted their

intuition, there seemed to be a difference in comfort level and confidence level in using

their intuitions with their clients for the novice, intermediate and expert counselors.








Receiving and Recognizing the Intuition

Although all participants indicated that they recognize an intuition as being for

their client, the modalities for that receiving and recognition varied for some participants.

All participants but Katie described the intuition as primarily coming though as a

feeling/bodily sensation that they translated into words to make meaning for the client.

Katie received and recognized her sense of knowing through several different modes

depending on the client and sometimes occurs as a feeling of being "driven to do

something." Katie described that she frequently receives intuitive information as

thoughts. For Katie, "A thought. .. Or the thought that this poem would be good for that

client. So it comes.... It definitely is a thought."

All of the modalities for receiving and recognizing intuition link well with how

intuition is written about in popular and scholarly literature (Day, 1996; Goldberg, 1983;

Naparstek. 1997; Petitmengin-Peugot, 1999) in that it can be recognized through

clairsentience (sensing or feeling an intuition kinesthetically or emotionally),

clairvoyance (seeing a vision or image that corresponds to a sense of knowing), or

clairaudience (hearing or thinking intuitive information).

Katie and Jera also receive and recognize the sense of knowing across several

modalities. Although Katie refers to it as a thought most of the time, she also refers to it

as "sense or see or vision somehow what they were trying to say before they even said

it." Jera also described seeing "'very vivid mental pictures of something that I feel

expresses what the client might be experiencing." However, Jera also receives and

recognizes intuitive information through feeling that something is for her client; for

example, she stated "it's like a feeling that you just know." Jera never specifically









described receiving or recognizing the intuition as a bodily sensation, although she does

mention that when she is not using her intuition in a session that she is "sort out of out

my body, in my head."

Woody described that he typically recognizes clinical intuition as an emotional

feeling that occurs in the moment that helps him figure out if a client is being

forthcoming, what the client might be feeling, or what might come next from the client.

According to Woody, "Feeling. Definitely feeling. .. I feel like my intuition is maybe

more attuned than a lot of people's. There are times I where I can just look at somebody

and tell what's going on. .. And it's definitely feeling. Definitely feeling." Once he gets

that feeling. Woody then translates it into a thought through his mind. Woody stated

"intuition means thinking or becoming aware of something that you're pretty sure about

but you wouldn't be able to confirm it unless you actually explore it."

Similarly to Woody in that he translates a feeling into thoughts, Alice and Molly

receive and recognize the intuition first in the body that they then translate into words

through the mind for the client. Unlike Jera and Woody, who use the word "feeling"' to

describe their recognition of intuition, Alice and Molly go beyond feeling and describe it

as a bodily sensation. Alice stated "And in the body, I would say, I just have a sense of it.

It triggers, I don't know, there's movement there. And then it goes directly to my mind. I

try to pull myself out of my mind, out of thinking." Molly described her intuition as

coming from "somewhere down in your diaphragm, along the power chakra, I think. It's

physical. It filters through the mind, everything has to come through the mind to put

words to it. It the genesis of it is not in the mind."








Additionally, nearly all participants but Katie described recognizing most of their

intuitions in the moment, during a session with a client. Although that occurs for Katie,

she tends to more frequently recognize the intervention as intuition when she reflects on

it after the session. Katie stated "'it's usually afterwards I realize it was intuition. I don't

really know it's intuition when it's happening."

Trusting of and Comfort in Using the Intuition

All participants indicated that they trusted their intuitions about clients; however

that trust and confidence in using their intuitions while counseling seemed to grow with

more experience. Alice, with the least amount of counseling experience, described herself

as still growing comfortable trusting intuition and knowing when to use it in a counseling

session. Molly, on the other end of the continuum with over 30 years of counseling

experience. indicated that she never questions whether the intuition is valid and brings it

into a counseling session frequently. The other participants tended to fall somewhere in

between Alice and Molly on the continuum. Despite the different levels of comfort and

trust regarding their clinical intuitions, all counselors seemed to describe that their

intuitions have not changed as they gained education and experience but the trusting of

and confidence in using grew.

For Alice, trusting and growing comfortable with her clinical intuition is

something that she is learning as she gets more experience. With one and a half years of

counseling experience, she is struggling with knowing when to share it with a client to

facilitate the counseling process. Alice stated "more often than not, never gets put in the

case notes, rarely even gets shared with the client. Because I just use the intuition as a

guide." Conceptualizing intuition as a guide for her work but not sharing it with clients,









Alice later stated that she thinks[] that's probably more about me and my level of

comfort in trusting the process. I sort of have this sense like I can't project onto my

clients that .. what may be their truth or not." Alice questions whether or not the

intuitions she regularly receives about the world and people is something she can bring

into a counseling session for fear of not wanting to impose on the client. As she

mentioned, she believes this will change as she grows more comfortable with the

counseling process, knowing what is okay to bring into sessions.

Molly confirms Alice's comments about her use of intuition when she first started

out counseling. Molly described that she has had to "educate my [her] sensing

capabilities, my observational sense. Because all my life, I've been very intuitive but I

didn't know `where did that come from?"' when she first began counseling. As she

gained experience and was in a different mindset than perhaps a novice like Alice, Molly

stated "I don't think my intuition has changed but I trust it more. Well, just with

experience and finding out what happens ifl come across with some really strong

intuition I have. I think it's just experience." Molly further described that acknowledging

or verifying her intuition is not necessary. According to Molly, "If I have it, I support it.

Not necessary."

Jera stated that she is still growing comfortable using her intuitions with clients

but that has changed with her experience. She stated:

I think the basic change has not been so much the intuition but the
confidence level in using it. Because I think my first two or three years of
counseling, I did have these feelings but I wonder if this is what it is and if
this is what the client needs to be presented with.

According to Woody, he always has had the intuition but with experience, he learned

how to use it more in the counseling session. Woody described "the feelings have been









there all along but I know how to use them almost .. until we have some sort of minimal

formal training, we're not exactly sure what to do with what we're able to perceive."

Katie actually discussed that she might rely on her intuition less now than she did

starting out in the profession, as she now knows what to do from the knowledge she has

gained with education and experience. However, Katie states that the amount of intuition

she receives in counseling have "'realistically, it's stayed the same."' To explain the

difference in relying on her intuition less now, Katie described "Maybe I recognize them

a little more now than I did them. I was flying by my seat on intuition a lot more then

than I am now. But I don't know if it's changed." Katie tends to conceptualize her

clinical intuition as a wonderful surprise when it happens and does not tend to rely on it

in case that reliance turns it off. Despite not relying on it, Katie described frequent uses of

her clinical intuition but still questions her intuitions with clients. Katie stated '"it just

surprises me every time. It' s almost like 'Why won't I trust it?' It just happens and I'm

just grateful and then I just move on."

Generating Intuition

The Counseling Relationship

All participants mentioned that the counseling relationship with the client was the

most important factor for making meaning of a clinical intuition. Without it, most

participants claimed that there would be no intuition coming forth in the session. To be

able to develop a relationship with their clients, most participants described a need to be

present and engaged in the session with the client for their intuition to also become

engaged.









Sense of rapport, connection and being present with the client. The clients

with whom the participants felt a strong sense of rapport in the counseling relationship

felt most present and engaged and thus recognized more intuitive insights about the

client. Without the sense of rapport or being present, most participants did not feel like

their intuition could engage. All participants mentioned that connection, rapport, and

presence as vital to intuition, although some of them discussed this important link in

terms of when it was lacking.

Jera stated .. where I am noticing some aversive personal habit, I feel like

there isn't really the rapport and the strength of relationship there to let the insight come."

Jera further goes on to add "Not really present. Not really open. That's what it feels like

to not be following my intuition." Woody stated "If you are comfortable enough .. with

a client, if you have a good rapport, if you meet for a few times or even if feel that

instance rapport, it s easy."

Alice, Katie, and Molly tend to describe that sense of being connected to the

client when the intuition comes into the session. Katie described ''energy passes between

us that passes along that sense of knowing. Their sense of knowing to me. So it becomes

a sense of knowing that I have about them." Katie goes on to further add "'intuition is a

process .. it isn't stagnant .. it goes from my client to me, from my client to me. ..

They're still in my mind, maybe even in my unconscious when something will come up

for me. So if I had not had the interaction with them .. there has to be something about

them that comes to me that triggers my intuition."

Molly describes it as "Nothing's going on if there is no contact. And that means

that we can't be in our heads, because nothing we think is ever present. We have to be in









our bodies, engaged with each other. And that's an intuitive process." Alice described the

connection with the client as "You're connecting with them as a human being and if you

are also tapping into the energy that they're presenting with." This is very similar to

Katie's and Molly's construction of connection and intuition with their clients.

Cyclical nature of intuition and the relationship. Not only did participants

indicate that the relationship was fundamental to their individual meaning-making of

clinical intuition with clients but the intuition also enhanced the relationship. For

participants, disclosing intuitions to their clients allowed the clients to feel more

understood which in turn further enhanced the counseling relationship. Woody stated "It

[the connection/relationship with a client] would probably enhance it [the intuition].

Because if you are making a connection, then you are probably on the right track and if

you are on the right track, the connection can get stronger. .. So it would probably

enhance the rapport."

For some participants, the connection between the counseling relationship and the

intuition made it important to gauge the appropriate time in disclosing that intuition. The

timing of disclosure was always linked back to making sure it was not going to hurt the

counseling relationship by determining the client's openness and readiness to accept the

intuition. Alice reported "when I feel very strongly about something that I don't feel is

going to jeopardize or harm the client, I will share it with them .. intuition is a very

subtle energy .. even though I am not taking responsibility for them, I'm taking

responsibility for what comes out of my mouth." Molly mentions that she "is very

cautious about what I do with my intuition, up to a point. And then at some point, I just

say 'Well, here it is kiddo' and I put it out .. [with] radical respect." Molly further goes








on to describe that she also uses her intuition in determining the time she puts another

intuitive insight out to the client.

Sometimes, the participants received intuitions about clients before they felt

enough of a sense of rapport with the client and were cautious that disclosing the intuition

could potentially hurt the relationship. Jera mentioned "if it is a really strong intuition, I

have to think about whether the client is ready for it. Because sometimes, I have the

intuition and the timing isn't right."

Communicating the Intuition

Similar to constructing the importance of the counseling relationship with

intuition, participants described disclosing intuitive insights to their clients in a very

respectful way, aimed at not hurting the strength of counseling relationship. The

participants disclosed intuitions using tentative phrasing, respectful questioning and were

always willing to be wrong so their clients could disagree with the intuition.

Tentative and Respectful Expression of the Intuition

All participants mentioned that they tend to use caution and respect when

disclosing an intuition for the client so as not to harm the counseling relationship. This

caution usually came out with clients as making a disclosure using language that was

very hesitant out of respect for the client and the counseling relationship. Woody

described this sense of phrasing as "'getting wiggle room" with a client, room to explore

an intuition without making it seem as though it is a certain statement of fact before

checking it out. Using an example of how he would disclose an intuition with a client,

Woody stated "I don't want to offend you, I don't want to scare you but I have something

in my mind and I want to check it out."









Woody further described the way he discloses and checks out intuitive

information with clients as being "very subtle"', which could also influence when he

decides to disclose insights to his clients. Woody also discusses frequently how the

intuition comes in service of the relationship and thus must be disclosed subtlely to not

damage the relationship. He stated that:

Sometimes I like students a lot. .. but the fact that I like them a lot,
might be a little more subtle about how I disclose because I don't want to
damage the relationship. .. and some counselors are like intuition, bam.
right in your face, this is what it is and you're wrong and you need to do
this and .. it might even be right. However, if the relationship is
damaged, how right were they?

For Woody, it seemed that having a pushy, overly arrogant attitude with disclosing an

intuition could damage the client and not be with sharing since it could harm the

counseling relationship and thus process.

Jera described a similar feeling to Woody in that she felt that she must assess how

the client will react to an intuition before sharing it and always stating it in such a way to

allow the client wiggle room. In an example of when she used intuition with a client, Jera

described how she shared the intuition with the client as "I said 'Right now, I'm getting

this really vivid image and it's very graphic and I wonder if it would be okay if I shared it

with you to get your reaction and see what you're thinking about this image I'm having."

By stating things in cautious language (1 wonder if, would it be okay if I shared it with

you), Jera phrased her intuition in a way to not harm the counseling relationship.

Alice also supports what Jera stated, adding that she is "always real careful about

how I say things. Try to be. .. There are times when I might just say "You know, I

kinda got this sense that X was happening with you." Alice used a powerful metaphor to

describe the respect for the client in sharing the intuition:









How can I best bring this [intuition] to the client? What ways are they
going to be receptive to it? Because if their receptivity is low, then what's
the point of sharing the intuition? So, for me, it's like getting a raw
diamond. It's beautiful but it's raw. It looks like a rock. So you get an
intuition. It's kind of the same thing and you say 'Now, how am I going to
cut, how am I going to work with the material? Because I can put some
cuts on that diamond and it's not gonna have any sparkle to it. The person
is going to look at it and say 'That's useless to me.' Go ahead and cut that
diamond in the right way and my god, it just blows you away how
beautiful it is. How much you see. It's the same thing.

Describing intuition as a raw diamond and cutting it for the client alludes to the idea that

for Alice, phrasing an intuition in the right (and respectful) way to the client allows for

the client to not feel defensive and get the most of the intuition.

Molly describes the tentative phrasing as being cautious and working with the

client's system in a respectful way when disclosing an intuition. For example, Molly

described what she might say to a client as "'This is coming to mind. I don't know if you

want to hear it but if you want to hear it, here it is. And I let them be the judge because it

is their system I am working with, not mine." By phrasing it a way using hesitant

language like "'I don't know" and "if you want to hear it," Molly is giving her clients the

wiggle room and respect to decide if they want to hear an intuition.

Katie uses tentative and respectful phrasing in general with clients but tends to

work the intuition into the flow of the session. For example, when describing a client she

worked with, Katie stated "You know, when I read this poem, your name popped into my

head and I just knew immediately this poem was perfect for you." Katie uses stronger

language but builds relationships with her clients that they can always disagree with what

she is saying so that disclosing the intuition is similar to how she reacts to clients

generally. However, with clients that she feels might not be ready to handle an intuition









or that it is in a touchy area, Katie stated "No, I wouldn't put it [the intuition] out. I saved

it. It also depends on how you put it."

Sense of Being Right

Since all participants stated that they phrase intuitive information respectfully and

cautiously, one reason for being so hesitant with disclosure is that they all feel their

intuitions are on target. Caring about the relationship and wanting to respect the client,

but feeling that their clinical intuition is by its nature correct, the participants phrased or

questioned clients regarding the intuition in such a way to allow the client the room for

escape if it was too much for them at a particular time or if it happened to be incorrect.

In describing their intuitions as being correct, participants stated it a variety of

ways. Molly reported that "intuition to come out into. it just does what it does. And in

my experience, it's right on target." Similarly to other participants, Katie referred to

disclosing her intuition as "just like let it out there. If I say to a client 'you seem to be

angry' they'll tell me if it's right or wrong. But the intuition is usually right, which is

amazing." Katie goes on further to reflect:

I only notice it as intuition because it has fallen into place. It if doesn't fall
into place. then I notice it but it was just a thought. You know, maybe
that's why people with intuition think they're always right. Because if it
doesn't fall into place, they don't notice it.

Katie's description indicates that when her intuition is not verified by the client, it was

not intuition.

Jera. Woody, and Alice use similar language to describe the same sense of being

right with their intuitions. Jera described it simply when discussing a client with whom

she shared an intuitive insight as "it did feel a little risky .. but I never thought 'what if

I'm wrong?"' Woody added "obviously if I find out that it's not the case, then I have to









change that. But in my experience, I'm usually not far off." Alice stated "It feels so right,

cellularly in your body. You just go 'Yes! '" indicating that her intuitions are correct most

of the time.

Willingness to be Wrong and Safety for the Client to Disagree

However, despite this sense that their intuitions are correct, all participants

discussed not assuming that the intuition was correct by wanting to check it out with the

client. They all check out an intuition with the client to make sure that the intuition had

meaning for the client and not just for the therapist. Additionally, this sense of acceptance

in being incorrect with the intuition also allowed for their clients to feel a sense of safety

in disagreeing with a disclosed intuitive insight, for the participants, creating this sense of

safety was vital to the process.

Molly described this not wanting to assume an intuition is correct when she stated

"it's my stuff and I always make that clear by just putting out 'This is me and I don't

know if it reverberates with you at all. And if not, just say so."' Katie referred to her

checking it out with the client and acceptance of being wrong as "I don't get turned down

too much or told that I'm wrong too often and plus I don't take it personally if I am

wrong." Alice also confirmed this by stating "Because number one, I'm okay with

rejection in that if they say 'No, that's not true for me."'

Using an example of how he would disclose an intuition with a client, Woody

stated "Now look, I might be wrong here and if I am, let me know." Jera also discussed

phrasing an intuition as "I1 wonder if" to give clients the room to disagree if they aren't

ready for it to come into the session. By phrasing their intuitive insights in such careful









ways, it creates comfort for the client to say if an intuition is incorrect. However, as

stated above, the client rarely disagrees with the counselors' expressed intuitions.

Boundaries and Benefits to Using Clinical Intuition

After communicating the intuition to their clients, usually the client moves in a

positive therapeutic direction. There are times, however, that the counselor does not

receive any intuition and thus does not get the benefit of using clinical intuition while

counseling.

Boundaries that Disengage Intuition

All participants described certain instances when their intuition might not be

engaged in a session. These reasons for "'turning off the intuition'' participants mentioned

are: some clients are too negative (all of the counselors described themselves as positive

or optimistic), too deeply enmeshed in their difficulties, have an attitude of this is not

worth my time or effort, or who elicit an emotional reaction in the counselor. Usually,

these circumstances arose from something elicited in them by a client.

For some participants, like Jera or Woody, their intuition "turned off' when

clients or a counseling session tended to get their (as counselors) emotions engaged in a

negative way. For other participants, it was when the client was not available or open to

counseling (Molly) and/or if they were in a very dark, unhealthy place at the beginning of

counseling (Katie). Unlike the other participants, attributing the times their intuition was

not engaged, Alice stated that it is because of not being present in the room. Alice was

hesitant to attribute that lack of presence as reaction to a client although from her

description, it almost seems similar to Jera and Woody, somehow getting triggered

emotionally and therefore not fully engaged with the client.









Jera and Woody both described that their emotional reactions to a counseling

session or client would turn off their intuition. For Jera, she described the predominant

emotion as anxiety; for Woody, he describes frustration. Jera stated "it's been vitally

important to keep my anxiety as low as possible so that I can be open to listening to my

own intuition in the room. [The anxiety] definitely gets in the way." Woody discussed

that "sometimes a kid frustrates me .. then my intuition is not [engaged] .and then my

emotions have gotten involved because I'm really frustrated with what's going on."

Molly described finding it difficult to engage her intuition with clients that are not

open or available to counseling but relates that to not fully engaging as a counselor, and

not just the intuition, with those clients. She stated "Generally, I think I would say

availability. People come in and they think they want to work on stuff but all they really

want to do is just gorge, just dump." Those kinds of clients are difficult to engage in true

counseling to Molly and thus difficult to engage her intuition.

Katie also describes not being fully engaged with some clients, both with those

who are not open to counseling and also with those who are in very dark and unhealthy

space at the beginning of counseling. Katie stated that "I just think part of it is that

they're not open." Furthermore, she said while describing one client,

It's like he is suffering so much and he brings this aura with him. .. I do
have a sense of my energy, it's tough to push my energy to give that to him
a little bit and then to also have intuition working too. I don't know if it's
possible, when their energy is sooooo down and black.

For Katie, who described herself as a very positive person, the negative feelings coming

from the client tended to make her much more knowledge-based in her work since her

intuition did not engage. I have to do some real knowledge stuff with people who are

down. .. I don't think you engage as much. .. In my experience, the people who I see









and have intuitive moments and I reflect with and do that stuff, they're not down at the

bottom. They've moved."

Benefits of Using Clinical Intuition

In disclosing their intuitions with clients, not only are the participants "checking

out"' the intuition with the client's experience of an event but also helping the client gain

meaning from that event to move the client toward therapeutic change. Discussing an

accurate intuition that a client is ready to hear is a powerful moment in therapy, where

great movement occurs according to all participants. The interviewees frequently

described the disclosure of an intuition leading to a different level of therapeutic work in

the session, often leading to intense turning points and speeding up the therapeutic

progress.

Helping clients gain meaning of intuition. One of the first ways the participants

described using their intuitions to help the client move toward change was to help the

client make individual meaning out of the intuition. The therapist provided their

constructed meaning of an intuition almost as a cue for the client to respond to and draw

his or her own individual meaning from it.

In an example of when she used intuition with a client, Jera mentioned "The

image that I shared with her was very gory, very kind of graphic but it really cemented a

couple of insights that she had already come to and coalesced in the image that she was

then able to take that image with her." The intuitive image served almost as a trigger for

Jera' s client to be able to put everything together and construct her own individual

meaning from it that she could then take with her.









Alice stated that when she shares an intuition with a client, the client could "say

'Oh my god, yeah. Wow. That's happening for me. .. and it completely takes their little

window of how they perceive everything and shifts it just a little bit and suddenly, things

move in a different direction for them." The client makes individual meaning out of what

Alice presented and uses it to move to a different place therapeutically.

Katie described a time with a client when she saw an intense color and connected

it to the client. She said "Just like if you were doing a reflection of feeling or reflection of

meaning, they tell you. It's like the guy afterwards with the aquamarine said 'You know,

when you said aquamarine, I was seeing that color."' Katie brought her intuition of that

color into the session and then facilitated the client's individual meaning-making of the

color.

Woody and Molly did not describe specific instances of helping their clients make

meaning of an intuition but throughout their interviews, the focus on checking it out with

the client implied to me that they also don't impose a meaning on an intuition. By not

imposing their own therapist's meaning on the intuition, they leave the intuition open to

the client's own meaning-making.

Creating turning points. The participants also described times in which working

with an intuition brought about a turning point for the client, either in the session or

afterward. However the common connection was that the therapist's intuition sparked a

change in the client (once they added their own individual meaning of it) that moved the

client to a different space therapeutically.

Katie described times when she did not directly disclose an intuition to a client

because it came to her as a need to do something. However, Katie ended up working with









the product to help the client gain meaning from the output of her clinical intuition. In

describing an example of this with a client, Katie said:

I felt I HAD to make her this hanging thing with beads and stuff and I
wanted to put an origami crane that I made on it. .. I just said "I made
you this. Take it to your next place you live."' And first off, she told me
red was her favorite color .. and that was it, I didn't hear from her. I
didn't think anything more about it. I had been driven to do it and then it
was over. About two years later, she wrote me an email and said "Your
origami crane has been hanging in my kitchen for the last two years and I
cannot tell you how much peace and solace and also how much it has
motivate me to do thing. And even though you aren't here, these are the
changes I've made in my life."

Katie's intuitive drive to make the crane ended up serving as a turning point for the

client; a constant reminder of where she wants to go and it gave her the peace and

motivation to move to a healthier place.

Woody described an instance working with a client when he received an intuition

that the client was using drugs, even though there was no indication of that in how she

presented. He stated "she would come and see me on a regular basis .. and she would

come in and she would talk about surface level stuff and I just flat out asked her 'How

often are you smoking marijuana?'" Allowing the client room to deny if she were using

marijuana, Woody used that intuition to confront the client. As a result, his intuitive

confrontation served as a turning point where they got off the surface level information

and then started doing real therapeutic work.

Jera described how she frequently sees her intuition in sessions to know what will

create turning points for her clients. She discussed:

Often at some point, I will just know they are going to turn a corner and I
will be so looking forward to their next session. Because my intuition tells
me that their readiness is peaked and they have the insight they need and
their motivation level is high and this is going to be the week.








For Jera, her intuitions can help her know when to use certain techniques or

confrontations because she intuitively knows the client is really for the challenge and thus

a turning point occurs. Similarly, Molly did not mention a specific example with a client,

but implied that her intuition "'gives me all the raw materials to use in coming up with

interventions."' As a result of those interventions, she helps her clients come to turning

points.

Speeding up the counseling process. Using their intuitions in counseling, the

participants also described how it allows them to speed up the process of counseling. As

with helping a client gain their own meaning and by reaching turning points, the using the

intuition ";as a guide" (Alice) or to help get to those turning points faster (Molly, Jera,

Woody, & Katie), the intuitive insights about clients move them toward change quickly.

Jera stated "it speeds things up so much." Woody described his clinical intuition as

"'We're wasting time and the intuition is a way to speed up the process."' Molly, Alice,

and Katie all implied that their intuitions help them get to the heart of a client's issue

more quickly without specifically stating it.














CHAPTER 5
IMPLICATIONS & CONCLUSIONS

Reflections on the Research Process

Interestingly, my experiences with clinical intuition are somewhat different than

my participants' experiences and by conducting research for this dissertation, I feel my

individual construction of intuition has changed. My own subjectivity created moments

when I was genuinely surprised that the analysis was taking something in a very different

direction than how I have personally experienced it. There were very many similarities: I

also would describe it as a sense of knowing or an awareness about a client that I

respectfully and tentatively express to a client to help move him/her toward therapeutic

change. I also use my intuition to determine appropriate interventions and the timing of

those interventions as some of my participants described. The main difference is that I

have never considered the counseling relationship to be an important aspect to intuition.

For me, intuition never seemed to result from having a strong rapport with a client,

although it certainly helped me feel more comfortable communicating an intuition to a

client.

Before starting this research, I never considered the counseling relationship to be

a vital factor because I never stopped to consider how I experience intuition differently

while counseling than in the rest of my life. As I have had intuitions about people I have

not had any contact with before, not having any sort of relationship with that person, I

assumed that this was the case in counseling. However, after listening to my participants









and analyzing their individualized constructions of clinical intuition, I started to

acknowledge that the counseling relationship has been vital for my own experiences with

clinical intuition. I cannot recall an instance when I received intuition about a client when

I was not engaged, fostering, and using the counseling relationship is some sense.

I also found myself agreeing with my participants as to times when my intuition

has not been engaged in counseling, usually with very gloomy or unhealthy clients, when

I am feeling an emotional reaction in the session (or in life in general), or when a client is

not engaged or available to the counseling process. In those instances, I tend to rely much

more on the knowledge and tools I have gained through education and experience,

similarly to my participants.

Limitations of the Current Study and Recommendations for Future Research

While such an open topic as intuition does not appear to lend itself well to the

structured nature of a grounded theory approach, a data-based theory did emerge from the

findings. The topic of clinical intuition is in some respects too broad to study using true

grounded theory; however, the initial shaping of the theory on clinical intuition in

counseling sets the stage for further research and refinement on the topic.

Another limitation is my use of constructivism as the theoretical foundation

behind the grounded theory methodology. Grounded theory has positivist roots but can be

approached through a constructivist lens (Charmaz, 2000; Charmaz, 2001; Strauss &

Corbin, 1998). However, at its core, grounded theory is much more positivist than

constructivist. Because the positivism inherent in grounded theory methods and the

theoretical foundation of constructivism are not an ideal match, future research on the









topic of clinical intuition in counseling should be conducted by more closely matching

the methodology to the theoretical foundation.

In qualitative research, the researcher is the analytical tool and as a result,

personal subjectivity of the researcher can influence the analysis. My personal

experiences with clinical intuition in counseling potentially influenced the data collection

and analysis; however, I tried to bracket my subjectivity as much as possible to keep it

from filtering into my research. By stating my subjectivities and personal reflections on

the research process, I hope to increase the trustworthiness and credibility of my data.

Although the theory of clinical intuition in counseling that arose in my study is

intriguing, it needs to be further developed and refined with a wider variety, number, and

type of participants. My sample ended up consisting of mainly white females, with one

white male. It is difficult to determine the trustworthiness of my data in reference to

counselors of more diverse backgrounds (such as gender, race, ethnicity, sexual

orientation, etc.) since they were not included in this study.

A limitation that arose during data collection and analysis was that the time

between the first interviews for both Woody and Katie and the follow-up interviews was

too much too long. Ideally, the follow-up interview would have occurred very soon after

their initial interviews but circumstances did not make that possible. Because of the long

time between interviews, I did not feel the data collected in the follow-ups was as rich as

it could have been if the first interviews had been fresher in their minds. As a result, the

less rich data could have potentially led to theoretical saturation more quickly with less

new, rich data coming in during the follow-up interviews.









In future research, I would continue to study the aspect of counselor experience in

further developing the theory. During the initial stages of my analysis, experience

appeared to play a larger role in the intuitive process in counseling but did not emerge

fully in the final theory. I would want to further study how counselors across different

experience levels make meaning of and use their intuitions with clients. The aspect of the

counseling relationship is another aspect that I would continue to explore in future

research, both in trying to gain a greater understanding of its role in the process and in

how it triggers an intuition in a counselor. This is an important aspect that must be

studied further to gain a wider understanding of the impact of the counseling relationship

variable in making meaning of and using intuition while counseling.

Conclusion

My analysis revealed that counselors' use of intuition can be of great benefit to

the counseling relationship and to the therapeutic progress of a client. By first receiving

and recognizing an intuition and then respectfully communicating it to the client, a

counselor can move her/him toward therapeutic change more quickly and with more

meaning than when their intuitions are not engaged. If using clinical intuition can speed

up the process of helping clients become more mentally "healthy," it should be

incorporated as a valid part of the counseling process, gaining acceptance and recognition

from counselor training programs, licensing boards, and third-party payers.

When their clinical intuition was not engaged in the counseling session, it was

usually a result of something not occurring within the counseling relationship, that is,

some boundary between the counselor and client and their relationship. My research

brings awareness to what kinds of clients or what kinds of emotions "'turn off" clinical









intuition in counselors, hopefully helping intuitive counselors recognize more quickly

when their intuitions were not engaged. Again, as clinical intuition brings great benefit to

the counseling session, it is important that counselors become aware of the instances

when it is not occurring, so they can improve the counseling relationship and therapeutic

progress for their clients.

All participants indicated that they felt their intuitions were correct and when

checked out, clients usually confirmed that the intuition was on target. If an intuition is

usually correct when shared with a client, then it is not faulty thinking or bias as some

critics argue (Gambril, 1990; Hall, 2002; Myers, 2002). It seems that in using the

counseling relationship to trigger intuitions about the client, a counselor is tapping into

some part of the client's reality. How that tapping into process occurs is still a mystery;

however, the result of that process, intuition, is not a mysterious, nebulous thing that we

must avoid at all costs if we are to be considered legitimate. It is something that seems to

greatly facilitate the counseling process.

The participants' meaning of clinical is intuition is similar to but different than

how I have defined it in chapter one: the speedy, unconscious knowing: (a) of

information about a client, (b) used to form hypotheses about a client without rational,

logical means (c) of what sort of treatments will work well with a client, and/or (d) used

to determine a new course of action with a client if feeling 'stuck'.

The participants described a sense of knowing (speedy, unconscious knowing)

about the client (of information about the client), that they communicate to their clients

(testing their intuitive insights/hypotheses about the client). Both Jera and Molly

specifically described using their intuition to help figure out interventions (what sort of









treatments work well). None of the participants described using their clinical intuition to

determine a new course of action with a client if feeling stuck. In fact, most participants

implied that either they did not get stuck with clients very often or that if they did get

stuck, it was because their intuition was not engaged in the session.

My definition did not incorporate an important aspect of clinical intuition that all

participants mentioned in my research: the importance of the counseling relationship in

generating a clinically intuitive insight. Very little of the literature mentions the necessary

rapport, strength and quality of the counseling relationship as generators of clinical

intuition in any discipline (nursing, medicine, business, or counseling). Redding (2001)

did postulate that caring is a basis for empathy and thus intuition in nurses, which is

similar to the idea of the counseling relationship as the basis of intuition, but she

conceptualized it more as qualities within the practitioner and not as a result of the

interaction.

None of my participants supported the idea that intuition is a form of reflection-

in-action or tacit knowledge (Schiin, 1983; Welsh & Lyons, 2001) or that it was mere

pattern recognition (Benner, 1984/2001; Benner & Tanner, 1987). They all distinguished

between clinical intuition and clinical knowledge in that intuition arises more

spontaneously, without knowing where it came from and knowledge is something that we

learned in our experience or education that we know we are using to generate clinical

ideas. My research indicates that although we primarily gain clinical knowledge with

experience and education, we do not gain more clinical intuition with experience, we just

trust it more.








The nursing literature implies that using intuition to help clients is a skill

practitioners gain with experience; thus, the more exposure they have to certain patterns

of patient behavior and vital signs, the more the nurses will understand how those

patterns fit together quickly. My findings did not support that view of clinical intuition in

counseling. Novice counselors have intuition but do not yet trust using it in session. With

experience, counselors begin to feel more confident and comfortable trusting and using

their clinical intuitions as part of the counseling process.

I believe that beginning counselors do not trust their intuitions because the

counseling field is becoming focused on outcome-based treatments and rigid diagnoses as

we try to gain legitimacy in the scientific and managed care worlds. A novice counselor

might enter a counseling program with strong intuition that can be used to help their

clients in sessions. However, these intuitions may be trained out, as a beginning

counselor learns that they must only use certain proscribed techniques and methods in

counseling a client. With time and experience, intermediate counselors learn to again

trust those clinical intuitions, matching them up with the knowledge and education from

training. Expert counselors have seen the results for many years of bringing their

intuitions back into the sessions that they do so more confidently and comfortably on a

regular basis.

All participants discussed a difference between clinical knowledge, technique,

and intuition in session and all discussed the importance of using both when with a client.

Making meaning out of clinical insight can help move the client to therapeutic change in

a speedy, meaningful way; however, the techniques and clinical knowledge developed in

counseling education, help counselors make sense of how to use their intuitions.




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